Survival of adults with primary malignant brain tumours in Europe; Results of the EUROCARE-5 study
Introduction
Tumours of the central nervous system (CNS) represent a relatively rare but serious health burden. In 2012, 57,000 new diagnoses of and 45,000 deaths for tumours of the brain and other parts of the CNS were estimated in Europe [1], [2]. CNS tumours occur at all ages: the malignant CNS tumours account for 16% of all childhood cancers combined [3], and 1–3% of all cancers, depending on the inclusion/exclusion of benign tumours [1], [4].
CNS tumours are classified into diagnostic categories [5], each with distinct pathological, epidemiological and prognostic characteristics. They are also subdivided into grade I–IV according to the World Health Organisation (WHO) grading system [5]. A strong correlation between grade and prognosis exists, with grade I having the most favourable and grade IV the poorest prognosis. Glioblastoma corresponds to WHO grade IV with a median survival <6 months [6]. As glioblastoma is the most frequent primary brain tumour, the overall prognosis of CNS tumours is very poor [7].
Treatment for CNS tumours mainly consists of surgical resection and, for high grade tumours, adjuvant radiotherapy. After having demonstrated an increase in the median survival in a clinical trial setting by 2.5 months [8], or 4.6 months in those having undergone complete resection [9], the alkylating agent temozolomide was added to the therapeutic arsenal against glioma.
Since survival comparisons for CNS tumours are hampered by differences in inclusion criteria or morphology subgroups distribution, the present paper describes survival for malignant neuroepithelial brain tumours across Europe and overtime, according to age and histology, in the context of the EUROCARE-5 study.
Section snippets
Materials and methods
Unique and multiple malignant (International Classification of Diseases for Oncology, 3rd revision [ICD-O-3] behaviour code/3 [10]) brain tumours (ICD-O-3 topography code C71), diagnosed up to the end of 2007 and followed up until December 2008 were considered. Eighty-six European cancer registries (CRs) in 28 countries divided into five European regions (Ireland/United Kingdom [UK], Northern, Central, Southern and Eastern Europe) could contribute to the analyses.
In order to minimise the effect
Results
A total of 83,458 malignant primary neuroepithelial brain tumours were analysed, of which 31% were archived in England, 11% in Germany and 9% in the Netherlands (Table 1). The proportion of MV cases showed a large variation between countries ranging from 61% (Scotland) to 100% (Poland).
About half of cases were glioblastoma, followed by other astrocytoma (19%), oligodendroglioma (9%), ependymoma (2%) and embryonal tumours (1%) (Supplementary Table 2). Eight percent of all cases were classified
Discussion
The present population-based study on survival for malignant neuroepithelial brain tumours included data from 24 European countries. The average 5-year RS in 2000–2007 was 20%, but below 10% for patients 65 years or older. Like in earlier EUROCARE studies we found disparities between countries. A small increase in 5-year RS was observed, being slightly larger in Northern, Central and Southern Europe than in Eastern Europe and Ireland/UK. A more pronounced increase up to 12 percentage points was
Role of funding source
The study was funded by the Compagnia di San Paolo, the Fondazione Cariplo Italy, the Italian Ministry of Health (Ricerca Finalizzata 2009, RF-2009-1529710) and the European Commission (European Action Against Cancer, EPAAC, Joint Action No. 20102202). The funding sources had no role in study design, the collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication.
Conflict of interest statement
None declared.
Acknowledgements
We thank Chiara Margutti, Simone Bonfarnuzzo and Camilla Amati for secretarial assistance.
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