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Girardi F, Di Carlo V, Stiller C, Gatta G, Woods RR, Visser O, Lacour B, Tucker TC, Coleman MP, Allemani C. Global survival trends for brain tumors, by histology: Analysis of individual records for 67,776 children diagnosed in 61 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:593-606. [PMID: 36215122 PMCID: PMC10013647 DOI: 10.1093/neuonc/noac232] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Tumors of the central nervous system are among the leading causes of cancer-related death in children. Population-based cancer survival reflects the overall effectiveness of a health care system in managing cancer. Inequity in access to care world-wide may result in survival disparities. METHODS We considered children (0-14 years) diagnosed with a brain tumor during 2000-2014, regardless of tumor behavior. Data underwent a rigorous, three-phase quality control as part of CONCORD-3. We implemented a revised version of the International Classification of Childhood Cancer (third edition) to control for under-registration of non-malignant astrocytic tumors. We estimated net survival using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 67,776 children. We estimated survival for 12 histology groups, each based on relevant ICD-O-3 codes. Age-standardized 5-year net survival for low-grade astrocytoma ranged between 84% and 100% world-wide during 2000-2014. In most countries, 5-year survival was 90% or more during 2000-2004, 2005-2009, and 2010-2014. Global variation in survival for medulloblastoma was much wider, with age-standardized 5-year net survival between 47% and 86% for children diagnosed during 2010-2014. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors in children, by histology. We devised an enhanced version of ICCC-3 to account for differences in cancer registration practices world-wide. Our findings may have public health implications, because low-grade glioma is 1 of the 6 index childhood cancers included by WHO in the Global Initiative for Childhood Cancer.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Veronica Di Carlo
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Brigitte Lacour
- National Registry of Childhood Solid Tumors, Faculty of Medicine -Vandœuvre-lès-Nancy Cedex, France.,National Registry of Childhood Cancers, CRESS EQ7, UMR-S 1153, INSERM, Université de Paris, Paris, France
| | - Thomas C Tucker
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA.,Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Girardi F, Allemani C, Coleman MP. Worldwide Trends in Survival From Common Childhood Brain Tumors: A Systematic Review. J Glob Oncol 2019; 5:1-25. [PMID: 31682549 PMCID: PMC6882508 DOI: 10.1200/jgo.19.00140] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The histology of brain tumors determines treatment and predicts outcome. Population-based survival reflects the effectiveness of a health care system in managing cancer. No systematic review of worldwide variation and time trends in survival from brain tumors in children is currently available. PATIENTS AND METHODS We considered longitudinal, observational studies comprising children diagnosed with intracranial astrocytic or embryonal tumors. We searched six electronic databases from database inception to September 30, 2018, using complex search strategies. The outcome measure was 5-year survival, estimated through a time-to-event analysis. This study is registered with PROSPERO, number CRD42018111981. RESULTS Among 5,244 studies, we identified 47 eligible articles that provided 228 survival estimates. Only five studies were entirely or partially conducted in low-income or middle-income countries. Five-year survival from embryonal tumors increased from 37% in 1980 to approximately 60% in 2009. Although survival for medulloblastoma improved substantially (from 29% to 73% during 1959-2009), survival for primitive neuroectodermal tumors wavered over time (1973-2009) and between countries. Five-year survival from astrocytoma changed very little over the 27 years between 1982 and 2009 (from 78% to 89%). Interpretation of the literature was made difficult by the heterogeneity of study designs. CONCLUSION Survival has improved for embryonal tumors, but little change has been observed for astrocytic tumors. We found a striking gap in knowledge about survival from childhood brain tumor subtypes in middle-income and low-income countries, where half of these tumors are diagnosed. Larger studies are needed, including in under-represented countries and based on standardized data collection, to provide up-to-date survival estimates.
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Affiliation(s)
- Fabio Girardi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Allemani
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P. Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Geyer JR, Sposto R, Jennings M, Boyett JM, Axtell RA, Breiger D, Broxson E, Donahue B, Finlay JL, Goldwein JW, Heier LA, Johnson D, Mazewski C, Miller DC, Packer R, Puccetti D, Radcliffe J, Tao ML, Shiminski-Maher T. Multiagent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: a report from the Children's Cancer Group. J Clin Oncol 2005; 23:7621-31. [PMID: 16234523 DOI: 10.1200/jco.2005.09.095] [Citation(s) in RCA: 288] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate response rate, event-free survival (EFS), and toxicity of two chemotherapeutic regimens for treatment of children younger than 36 months with malignant brain tumors and to estimate control intervals without irradiation in children with no residual tumor after initial surgery and induction chemotherapy and with delayed irradiation in patients with residual tumor or metastatic disease at diagnosis. PATIENTS AND METHODS Patients were randomly assigned to one of two regimens of induction chemotherapy (vincristine, cisplatin, cyclophosphamide, and etoposide v vincristine, carboplatin, ifosfamide, and etoposide). Maintenance chemotherapy began after induction in children without progressive disease. Children with no residual tumors after induction therapy and no metastatic disease at diagnosis were not to receive radiation therapy unless their tumors progressed. RESULTS Two hundred ninety-nine infants were enrolled. Forty-two percent of patients responded to induction chemotherapy. At 5 years from study entry, the EFS rate was 27% +/- 3%, and the survival rate was 43% +/- 3%. There was no significant difference between the two arms in terms of response rate or EFS. For medulloblastoma, supratentorial primitive neuroectodermal tumor, ependymoma, and rhabdoid tumors, 5-year EFS rates were 32% +/- 5%, 17% +/- 6%, and 32% +/- 6%, and 14% +/- 7%, respectively. Fifty-eight percent of patients who were alive 5 years after study entry had not received radiation therapy. CONCLUSION Intensified induction chemotherapy resulted in a high response rate of malignant brain tumors in infants. Survival was comparable to that of previous studies, and most patients who survived did not receive radiation therapy.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Brain Neoplasms/drug therapy
- Brain Neoplasms/radiotherapy
- Brain Neoplasms/surgery
- Child, Preschool
- Cisplatin/administration & dosage
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Ependymoma/drug therapy
- Ependymoma/radiotherapy
- Ependymoma/surgery
- Etoposide/administration & dosage
- Female
- Glioma/drug therapy
- Glioma/radiotherapy
- Glioma/surgery
- Humans
- Ifosfamide/administration & dosage
- Infant
- Infant, Newborn
- Male
- Medulloblastoma/drug therapy
- Medulloblastoma/radiotherapy
- Medulloblastoma/surgery
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/radiotherapy
- Neoplasms, Germ Cell and Embryonal/surgery
- Neuroectodermal Tumors, Primitive, Peripheral/drug therapy
- Neuroectodermal Tumors, Primitive, Peripheral/radiotherapy
- Neuroectodermal Tumors, Primitive, Peripheral/surgery
- Survival Rate
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- J Russell Geyer
- Children's Hospital and Regional Medical Center, Department of Pediatric Hematology-Oncology, Seattle, WA 98105, USA.
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Abstract
The prognosis in infants with brain tumors has historically been very poor. This study reviews 16 infants under the age of 12 months with brain tumors who presented to our institution between 1988 and 1999. The aim was to describe the clinical presentation, diagnosis, and management of these patients and to establish if newer diagnostic and treatment modalities have improved prognosis in terms of survival and neurocognitive outcome. Charts were reviewed retrospectively for age at diagnosis, time to diagnosis, presenting features, location, histology, surgical and adjuvant treatment, survival, and neurocognitive outcome. Survival has improved. Three quarters of the patients remain alive. The 5-year survival rate was 81%. The 5-year progression-free survival rate was 51%, with a median follow-up time of 70 months. The 5-year survival rate for benign tumors was 100%. None of the children with malignant tumors survived. Morbidity remains high: 8 of 13 survivors had focal neurologic deficits, 7 of 13 had epilepsy, and 7 of 12 had significant cognitive disability. Future treatment protocols should include formal analysis of neurocognitive morbidity, functional outcome, and quality of life measures to provide accurate prognostic information and to prepare families for early intervention programs.
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Affiliation(s)
- Helen K Young
- Neurology Department, Sydney Children's Hospital, Randwick, NSW, Australia.
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