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Girardi F, Matz M, Stiller C, You H, Marcos Gragera R, Valkov MY, Bulliard JL, De P, Morrison D, Wanner M, O'Brian DK, Saint-Jacques N, Coleman MP, Allemani C, Hamdi-Chérif M, Kara L, Meguenni K, Regagba D, Bayo S, Cheick Bougadari T, Manraj SS, Bendahhou K, Ladipo A, Ogunbiyi OJ, Somdyala NIM, Chaplin MA, Moreno F, Calabrano GH, Espinola SB, Carballo Quintero B, Fita R, Laspada WD, Ibañez SG, Lima CA, Da Costa AM, De Souza PCF, Chaves J, Laporte CA, Curado MP, de Oliveira JC, Veneziano CLA, Veneziano DB, Almeida ABM, Latorre MRDO, Rebelo MS, Santos MO, Azevedo e Silva G, Galaz JC, Aparicio Aravena M, Sanhueza Monsalve J, Herrmann DA, Vargas S, Herrera VM, Uribe CJ, Bravo LE, Garcia LS, Arias-Ortiz NE, Morantes D, Jurado DM, Yépez Chamorro MC, Delgado S, Ramirez M, Galán Alvarez YH, Torres P, Martínez-Reyes F, Jaramillo L, Quinto R, Castillo J, Mendoza M, Cueva P, Yépez JG, Bhakkan B, Deloumeaux J, Joachim C, Macni J, Carrillo R, Shalkow Klincovstein J, Rivera Gomez R, Perez P, Poquioma E, Tortolero-Luna G, Zavala D, Alonso R, Barrios E, Eckstrand A, Nikiforuk C, Woods RR, Noonan G, Turner D, Kumar E, Zhang B, Dowden JJ, Doyle GP, Saint-Jacques N, Walsh G, Anam A, De P, McClure CA, Vriends KA, Bertrand C, Ramanakumar AV, Davis L, Kozie S, Freeman T, George JT, Avila RM, O’Brien DK, Holt A, Almon L, Kwong S, Morris C, Rycroft R, Mueller L, Phillips CE, Brown H, Cromartie B, Ruterbusch J, Schwartz AG, Levin GM, Wohler B, Bayakly R, Ward KC, Gomez SL, McKinley M, Cress R, Davis J, Hernandez B, Johnson CJ, Morawski BM, Ruppert LP, Bentler S, Charlton ME, Huang B, Tucker TC, Deapen D, Liu L, Hsieh MC, Wu XC, Schwenn M, Stern K, Gershman ST, Knowlton RC, Alverson G, Weaver T, Desai J, Rogers DB, Jackson-Thompson J, Lemons D, Zimmerman HJ, Hood M, Roberts-Johnson J, Hammond W, Rees JR, Pawlish KS, Stroup A, Key C, Wiggins C, Kahn AR, Schymura MJ, Radhakrishnan S, Rao C, Giljahn LK, Slocumb RM, Dabbs C, Espinoza RE, Aird KG, Beran T, Rubertone JJ, Slack SJ, Oh J, Janes TA, Schwartz SM, Chiodini SC, Hurley DM, Whiteside MA, Rai S, Williams MA, Herget K, Sweeney C, Kachajian J, Keitheri Cheteri MB, Migliore Santiago P, Blankenship SE, Conaway JL, Borchers R, Malicki R, Espinoza J, Grandpre J, Weir HK, Wilson R, Edwards BK, Mariotto A, Rodriguez-Galindo C, Wang N, Yang L, Chen JS, Zhou Y, He YT, Song GH, Gu XP, Mei D, Mu HJ, Ge HM, Wu TH, Li YY, Zhao DL, Jin F, Zhang JH, Zhu FD, Junhua Q, Yang YL, Jiang CX, Biao W, Wang J, Li QL, Yi H, Zhou X, Dong J, Li W, Fu FX, Liu SZ, Chen JG, Zhu J, Li YH, Lu YQ, Fan M, Huang SQ, Guo GP, Zhaolai H, Wei K, Chen WQ, Wei W, Zeng H, Demetriou AV, Mang WK, Ngan KC, Kataki AC, Krishnatreya M, Jayalekshmi PA, Sebastian P, George PS, Mathew A, Nandakumar A, Malekzadeh R, Roshandel G, Keinan-Boker L, Silverman BG, Ito H, Koyanagi Y, Sato M, Tobori F, Nakata I, Teramoto N, Hattori M, Kaizaki Y, Moki F, Sugiyama H, Utada M, Nishimura M, Yoshida K, Kurosawa K, Nemoto Y, Narimatsu H, Sakaguchi M, Kanemura S, Naito M, Narisawa R, Miyashiro I, Nakata K, Mori D, Yoshitake M, Oki I, Fukushima N, Shibata A, Iwasa K, Ono C, Matsuda T, Nimri O, Jung KW, Won YJ, Alawadhi E, Elbasmi A, Ab Manan A, Adam F, Nansalmaa E, Tudev U, Ochir C, Al Khater AM, El Mistiri MM, Lim GH, Teo YY, Chiang CJ, Lee WC, Buasom R, Sangrajrang S, Suwanrungruang K, Vatanasapt P, Daoprasert K, Pongnikorn D, Leklob A, Sangkitipaiboon S, Geater SL, Sriplung H, Ceylan O, Kög I, Dirican O, Köse T, Gurbuz T, Karaşahin FE, Turhan D, Aktaş U, Halat Y, Eser S, Yakut CI, Altinisik M, Cavusoglu Y, Türkköylü A, Üçüncü N, Hackl M, Zborovskaya AA, Aleinikova OV, Henau K, Van Eycken L, Atanasov TY, Valerianova Z, Šekerija M, Dušek L, Zvolský M, Steinrud Mørch L, Storm H, Wessel Skovlund C, Innos K, Mägi M, Malila N, Seppä K, Jégu J, Velten M, Cornet E, Troussard X, Bouvier AM, Guizard AV, Bouvier V, Launoy G, Dabakuyo Yonli S, Poillot ML, Maynadié M, Mounier M, Vaconnet L, Woronoff AS, Daoulas M, Robaszkiewicz M, Clavel J, Poulalhon C, Desandes E, Lacour B, Baldi I, Amadeo B, Coureau G, Monnereau A, Orazio S, Audoin M, D’Almeida TC, Boyer S, Hammas K, Trétarre B, Colonna M, Delafosse P, Plouvier S, Cowppli-Bony A, Molinié F, Bara S, Ganry O, Lapôtre-Ledoux B, Daubisse-Marliac L, Bossard N, Uhry Z, Estève J, Stabenow R, Wilsdorf-Köhler H, Eberle A, Luttmann S, Löhden I, Nennecke AL, Kieschke J, Sirri E, Justenhoven C, Reinwald F, Holleczek B, Eisemann N, Katalinic A, Asquez RA, Kumar V, Petridou E, Ólafsdóttir EJ, Tryggvadóttir L, Murray DE, Walsh PM, Sundseth H, Harney M, Mazzoleni G, Vittadello F, Coviello E, Cuccaro F, Galasso R, Sampietro G, Giacomin A, Magoni M, Ardizzone A, D’Argenzio A, Di Prima AA, Ippolito A, Lavecchia AM, Sutera Sardo A, Gola G, Ballotari P, Giacomazzi E, Ferretti S, Dal Maso L, Serraino D, Celesia MV, Filiberti RA, Pannozzo F, Melcarne A, Quarta F, Andreano A, Russo AG, Carrozzi G, Cirilli C, Cavalieri d’Oro L, Rognoni M, Fusco M, Vitale MF, Usala M, Cusimano R, Mazzucco W, Michiara M, Sgargi P, Boschetti L, Marguati S, Chiaranda G, Seghini P, Maule MM, Merletti F, Spata E, Tumino R, Mancuso P, Cassetti T, Sassatelli R, Falcini F, Giorgetti S, Caiazzo AL, Cavallo R, Piras D, Bella F, Madeddu A, Fanetti AC, Maspero S, Carone S, Mincuzzi A, Candela G, Scuderi T, Gentilini MA, Rizzello R, Rosso S, Caldarella A, Intrieri T, Bianconi F, Contiero P, Tagliabue G, Rugge M, Zorzi M, Beggiato S, Brustolin A, Gatta G, De Angelis R, Vicentini M, Zanetti R, Stracci F, Maurina A, Oniščuka M, Mousavi M, Steponaviciene L, Vincerževskienė I, Azzopardi MJ, Calleja N, Siesling S, Visser O, Johannesen TB, Larønningen S, Trojanowski M, Macek P, Mierzwa T, Rachtan J, Rosińska A, Kępska K, Kościańska B, Barna K, Sulkowska U, Gebauer T, Łapińska JB, Wójcik-Tomaszewska J, Motnyk M, Patro A, Gos A, Sikorska K, Bielska-Lasota M, Didkowska JA, Wojciechowska U, Forjaz de Lacerda G, Rego RA, Carrito B, Pais A, Bento MJ, Rodrigues J, Lourenço A, Mayer-da-Silva A, Coza D, Todescu AI, Valkov MY, Gusenkova L, Lazarevich O, Prudnikova O, Vjushkov DM, Egorova A, Orlov A, Pikalova LV, Zhuikova LD, Adamcik J, Safaei Diba C, Zadnik V, Žagar T, De-La-Cruz M, Lopez-de-Munain A, Aleman A, Rojas D, Chillarón RJ, Navarro AIM, Marcos-Gragera R, Puigdemont M, Rodríguez-Barranco M, Sánchez Perez MJ, Franch Sureda P, Ramos Montserrat M, Chirlaque López MD, Sánchez Gil A, Ardanaz E, Guevara M, Cañete-Nieto A, Peris-Bonet R, Carulla M, Galceran J, Almela F, Sabater C, Khan S, Pettersson D, Dickman P, Staehelin K, Struchen B, Egger Hayoz C, Rapiti E, Schaffar R, Went P, Mousavi SM, Bulliard JL, Maspoli-Conconi M, Kuehni CE, Redmond SM, Bordoni A, Ortelli L, Chiolero A, Konzelmann I, Rohrmann S, Wanner M, Broggio J, Rashbass J, Stiller C, Fitzpatrick D, Gavin A, Morrison DS, Thomson CS, Greene G, Huws DW, Grayson M, Rawcliffe H, Allemani C, Coleman MP, Di Carlo V, Girardi F, Matz M, Minicozzi P, Sanz N, Ssenyonga N, James D, Stephens R, Chalker E, Smith M, Gugusheff J, You H, Qin Li S, Dugdale S, Moore J, Philpot S, Pfeiffer R, Thomas H, Silva Ragaini B, Venn AJ, Evans SM, Te Marvelde L, Savietto V, Trevithick R, Aitken J, Currow D, Fowler C, Lewis C. Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:580-592. [PMID: 36355361 PMCID: PMC10013649 DOI: 10.1093/neuonc/noac217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. METHODS We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults. 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 by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.
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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
| | - Melissa Matz
- 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
| | - Hui You
- Cancer Information Analysis Unit, Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Rafael Marcos Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Mikhail Y Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Neuchâtel and Jura Tumour Registry, Neuchâtel, Switzerland
| | - Prithwish De
- Surveillance and Cancer Registry, and Research Office, Clinical Institutes and Quality Programs, Ontario Health, Toronto, Ontario, Canada
| | - David Morrison
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, UK
| | - Miriam Wanner
- Cancer Registry Zürich, Zug, Schaffhausen and Schwyz, University Hospital Zürich, Zürich, Switzerland
| | - David K O'Brian
- Alaska Cancer Registry, Alaska Department of Health and Social Services, Anchorage, Alaska, USA
| | - Nathalie Saint-Jacques
- Department of Medicine and Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - 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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Hauptmann M, Fossa SD, Stovall M, van Leeuwen FE, Johannesen TB, Rajaraman P, Gilbert ES, Smith SA, Weathers RE, Aleman BMP, Andersson M, Curtis RE, Dores GM, Fraumeni JF, Hall P, Holowaty EJ, Joensuu H, Kaijser M, Kleinerman RA, Langmark F, Lynch CF, Pukkala E, Storm HH, Vaalavirta L, van den Belt-Dusebout AW, Travis LB, Morton LM. Increased stomach cancer risk following radiotherapy for testicular cancer. Br J Cancer 2015; 112:44-51. [PMID: 25349972 PMCID: PMC4453604 DOI: 10.1038/bjc.2014.552] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Abdominal radiotherapy for testicular cancer (TC) increases risk for second stomach cancer, although data on the radiation dose-response relationship are sparse. METHODS In a cohort of 22,269 5-year TC survivors diagnosed during 1959-1987, doses to stomach subsites were estimated for 92 patients who developed stomach cancer and 180 matched controls. Chemotherapy details were recorded. Odds ratios (ORs) were estimated using logistic regression. RESULTS Cumulative incidence of second primary stomach cancer was 1.45% at 30 years after TC diagnosis. The TC survivors who received radiotherapy (87 (95%) cases, 151 (84%) controls) had a 5.9-fold (95% confidence interval (CI) 1.7-20.7) increased risk of stomach cancer. Risk increased with increasing stomach dose (P-trend<0.001), with an OR of 20.5 (3.7-114.3) for ⩾50.0 Gy compared with <10 Gy. Radiation-related risks remained elevated ⩾20 years after exposure (P<0.001). Risk after any chemotherapy was not elevated (OR=1.1; 95% CI 0.5-2.5; 14 cases and 23 controls). CONCLUSIONS Radiotherapy for TC involving parts of the stomach increased gastric cancer risk for several decades, with the highest risks after stomach doses of ⩾30 Gy. Clinicians should be aware of these excesses when previously irradiated TC survivors present with gastrointestinal symptoms and when any radiotherapy is considered in newly diagnosed TC patients.
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Affiliation(s)
- M Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - S D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - M Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - P Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - E S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - S A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B M P Aleman
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - R E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - G M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - J F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - H Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - M Kaijser
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - R A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | | | - C F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - H H Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - L Vaalavirta
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - A W van den Belt-Dusebout
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - L B Travis
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - L M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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3
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Dores GM, Curtis RE, van Leeuwen FE, Stovall M, Hall P, Lynch CF, Smith SA, Weathers RE, Storm HH, Hodgson DC, Kleinerman RA, Joensuu H, Johannesen TB, Andersson M, Holowaty EJ, Kaijser M, Pukkala E, Vaalavirta L, Fossa SD, Langmark F, Travis LB, Fraumeni JF, Aleman BM, Morton LM, Gilbert ES. Pancreatic cancer risk after treatment of Hodgkin lymphoma. Ann Oncol 2014; 25:2073-2079. [PMID: 25185241 PMCID: PMC4176454 DOI: 10.1093/annonc/mdu287] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/19/2014] [Accepted: 07/20/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although elevated risks of pancreatic cancer have been observed in long-term survivors of Hodgkin lymphoma (HL), no prior study has assessed the risk of second pancreatic cancer in relation to radiation dose and specific chemotherapeutic agents. PATIENTS AND METHODS We conducted an international case-control study within a cohort of 19 882 HL survivors diagnosed from 1953 to 2003 including 36 cases and 70 matched controls. RESULTS Median ages at HL and pancreatic cancer diagnoses were 47 and 60.5 years, respectively; median time to pancreatic cancer was 19 years. Pancreatic cancer risk increased with increasing radiation dose to the pancreatic tumor location (Ptrend = 0.005) and increasing number of alkylating agent (AA)-containing cycles of chemotherapy (Ptrend = 0.008). The odds ratio (OR) for patients treated with both subdiaphragmatic radiation (≥10 Gy) and ≥6 AA-containing chemotherapy cycles (13 cases, 6 controls) compared with patients with neither treatment was 17.9 (95% confidence interval 3.5-158). The joint effect of these two treatments was significantly greater than additive (P = 0.041) and nonsignificantly greater than multiplicative (P = 0.29). Especially high risks were observed among patients receiving ≥8400 mg/m(2) of procarbazine with nitrogen mustard or ≥3900 mg/m(2) of cyclophosphamide. CONCLUSION Our study demonstrates for the first time that both radiotherapy and chemotherapy substantially increase pancreatic cancer risks among HL survivors treated in the past. These findings extend the range of nonhematologic cancers associated with chemotherapy and add to the evidence that the combination of radiotherapy and chemotherapy can lead to especially large risks.
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Affiliation(s)
- G M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda; Department of Veterans Affairs Medical Center, Oklahoma City, USA.
| | - R E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston,USA
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - C F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, USA
| | - S A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston,USA
| | - R E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston,USA
| | - H H Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - D C Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto,Canada
| | - R A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda
| | - H Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - M Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - E J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto,Canada
| | - M Kaijser
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki and School of Health Sciences, University of Tampere, Tampere, Finland
| | - L Vaalavirta
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - S D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - L B Travis
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester,USA
| | - J F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda
| | - B M Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda
| | - E S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda
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Knudsen-Baas KM, Johannesen TB, Engeland A, Engelsen BA, Storstein AM, Owe JF. O9.10 * ANTI-EPILEPTIC TREATMENT IN GLIOMA, A NORWEGIAN POPULATION-BASED STUDY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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5
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Walters S, Maringe C, Butler J, Rachet B, Barrett-Lee P, Bergh J, Boyages J, Christiansen P, Lee M, Wärnberg F, Allemani C, Engholm G, Fornander T, Gjerstorff ML, Johannesen TB, Lawrence G, McGahan CE, Middleton R, Steward J, Tracey E, Turner D, Richards MA, Coleman MP. Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study. Br J Cancer 2013; 108:1195-208. [PMID: 23449362 PMCID: PMC3619080 DOI: 10.1038/bjc.2013.6] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/11/2012] [Accepted: 12/16/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We investigate whether differences in breast cancer survival in six high-income countries can be explained by differences in stage at diagnosis using routine data from population-based cancer registries. METHODS We analysed the data on 257,362 women diagnosed with breast cancer during 2000-7 and registered in 13 population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK. Flexible parametric hazard models were used to estimate net survival and the excess hazard of dying from breast cancer up to 3 years after diagnosis. RESULTS Age-standardised 3-year net survival was 87-89% in the UK and Denmark, and 91-94% in the other four countries. Stage at diagnosis was relatively advanced in Denmark: only 30% of women had Tumour, Nodes, Metastasis (TNM) stage I disease, compared with 42-45% elsewhere. Women in the UK had low survival for TNM stage III-IV disease compared with other countries. CONCLUSION International differences in breast cancer survival are partly explained by differences in stage at diagnosis, and partly by differences in stage-specific survival. Low overall survival arises if the stage distribution is adverse (e.g. Denmark) but stage-specific survival is normal; or if the stage distribution is typical but stage-specific survival is low (e.g. UK). International differences in staging diagnostics and stage-specific cancer therapies should be investigated.
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Affiliation(s)
- S Walters
- Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.
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Morton LM, Gilbert ES, Hall P, Andersson M, Joensuu H, Vaalavirta L, Dores GM, Stovall M, Holowaty EJ, Lynch CF, Curtis RE, Smith SA, Kleinerman RA, Kaijser M, Storm HH, Pukkala E, Weathers RE, Linet MS, Rajaraman P, Fraumeni JF, Brown LM, van Leeuwen FE, Fossa SD, Johannesen TB, Langmark F, Lamart S, Travis LB, Aleman BMP. Risk of treatment-related esophageal cancer among breast cancer survivors. Ann Oncol 2012; 23:3081-3091. [PMID: 22745217 PMCID: PMC3501231 DOI: 10.1093/annonc/mds144] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 04/10/2012] [Accepted: 04/16/2012] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Radiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use. DESIGN Nested case-control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records. RESULTS The largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (P(trend )< 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7-28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2-0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking). CONCLUSIONS Esophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up.
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Affiliation(s)
- L M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA.
| | - E S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - M Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Joensuu
- Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - L Vaalavirta
- Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - G M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA; US Department of Veterans Affairs Medical Center, Oklahoma City
| | - M Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, USA
| | - R E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - S A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - M Kaijser
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - H H Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - R E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - P Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - J F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - L M Brown
- Statistics & Epidemiology, RTI International, Rockville, USA
| | - F E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | | | - S Lamart
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, USA
| | - L B Travis
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, USA
| | - B M P Aleman
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Rogne SG, Rønning P, Helseth E, Johannesen TB, Langberg CW, Lote K, Scheie D, Meling TR. Craniotomy for brain metastases: a consecutive series of 316 patients. Acta Neurol Scand 2012; 126:23-31. [PMID: 21902675 DOI: 10.1111/j.1600-0404.2011.01590.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the incidence of craniotomy for brain metastases, overall survival (OS), surgical mortality, and prognostic factors in a large, contemporary, consecutive series from a well-defined catchment area. MATERIAL AND METHODS All patients ≥ 18 years who underwent craniotomies for intracranial metastases at Oslo University Hospital, Rikshospitalet and Ullevål, between 2005 and June 30, 2009 were included (n = 316). Patients were identified from our prospectively collected database and a thorough review of all charts to validate the entered data was performed. RESULTS The annual incidence of first-time craniotomy for a brain metastasis was 2.6/100,000 inhabitants. Patient age ranged from 25 to 87 years (median 64 years). The 30-day mortality rate was 3.8%. Median OS was 9.2 months. Recursive partitioning analysis was class I in 19.6%, class II in 59.2%, and class III in 21.2% with median OS of 16.2, 8.9, and 5.6 months, respectively (P < 0.001). Lung cancer and melanoma were associated with a higher risk (>1% per year) of developing brain metastases. Significant negative prognostic factors were age ≥ 65, a poor performance score, unstable extracranial disease, presence of extracranial metastases, multiplicity, metastasis in eloquent area, and no post-operative radiotherapy. CONCLUSIONS In this population study, the annual incidence of a first-time craniotomy for a brain metastasis was 2.6/100,000, the 30-day mortality rate was 3.8%, and median OS was 9.2 months. The well-known prognostic factors were confirmed.
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Affiliation(s)
- S G Rogne
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, Nur U, Tracey E, Coory M, Hatcher J, McGahan CE, Turner D, Marrett L, Gjerstorff ML, Johannesen TB, Adolfsson J, Lambe M, Lawrence G, Meechan D, Morris EJ, Middleton R, Steward J, Richards MA. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 2011; 377:127-38. [PMID: 21183212 PMCID: PMC3018568 DOI: 10.1016/s0140-6736(10)62231-3] [Citation(s) in RCA: 869] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival. METHODS Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995-2007, with follow-up to Dec 31, 2007. Data quality control and analyses were done centrally with a common protocol, overseen by external experts. We estimated 1-year and 5-year relative survival, constructing 252 complete life tables to control for background mortality by age, sex, and calendar year. We report age-specific and age-standardised relative survival at 1 and 5 years, and 5-year survival conditional on survival to the first anniversary of diagnosis. We also examined incidence and mortality trends during 1985-2005. FINDINGS Relative survival improved during 1995-2007 for all four cancers in all jurisdictions. Survival was persistently higher in Australia, Canada, and Sweden, intermediate in Norway, and lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older. International differences narrowed at all ages for breast cancer, from about 9% to 5% at 1 year and from about 14% to 8% at 5 years, but less or not at all for the other cancers. For colorectal cancer, the international range narrowed only for patients aged 65 years and older, by 2-6% at 1 year and by 2-3% at 5 years. INTERPRETATION Up-to-date survival trends show increases but persistent differences between countries. Trends in cancer incidence and mortality are broadly consistent with these trends in survival. Data quality and changes in classification are not likely explanations. The patterns are consistent with later diagnosis or differences in treatment, particularly in Denmark and the UK, and in patients aged 65 years and older. FUNDING Department of Health, England; and Cancer Research UK.
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Affiliation(s)
- M P Coleman
- Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.
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Helseth R, Helseth E, Johannesen TB, Langberg CW, Lote K, Rønning P, Scheie D, Vik A, Meling TR. Overall survival, prognostic factors, and repeated surgery in a consecutive series of 516 patients with glioblastoma multiforme. Acta Neurol Scand 2010; 122:159-67. [PMID: 20298491 DOI: 10.1111/j.1600-0404.2010.01350.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To study overall survival (OS), prognostic factors, and repeated surgery in glioblastoma multiforme (GBM). MATERIAL AND METHODS Retrospective study of 516 consecutive adult patients who underwent primary surgery for a GBM in year 2003-2008. RESULTS Median age at primary surgery was 63.7 years (range 18.0-88.0). Median OS was 9.9 months. Age > 60 years, poor preoperative ECOG score, bilateral tumor, biopsy rather than resection, and no temozolomide chemoradiotherapy were negative risk factors. Repeat surgery was performed in 65 patients (13%). Median time between first and second surgery was 7 months. Indications for second surgery were increasing neurological deficits (35.4%), raised ICP (33.8%), asymptomatic but reoperated because of tumor progression verified on MRI (20.0%), and epileptic seizures (11%). Patients who underwent repeated surgery had longer OS; 18.4 months vs 8.6 months (P < 0.001). CONCLUSIONS OS for adult GBM patients was 9.9 months. Negative prognostic factors were increasing age, poor neurological function, bilateral tumor involvement, biopsy instead of resection, and RT alone compared to temozolomide chemoradiotherapy. Our rate of repeated surgery for GBM was 13% and the main indications for second surgery were raised ICP and increasing neurological deficits. In a carefully selected group of patients, repeat surgery significantly prolongs OS.
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Affiliation(s)
- R Helseth
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
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Andreassen KE, Grotmol T, Cvancarova M, Johannesen TB, Fossa SD. Risk of metachronous contralateral testicular germ cell tumor (met-TGCT) among 7,248 Norwegian patients (1953-2007). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rogne SG, Konglund A, Meling TR, Scheie D, Johannesen TB, Rønning P, Helseth E. Intracranial tumor surgery in patients >70 years of age: is clinical practice worthwhile or futile? Acta Neurol Scand 2009; 120:288-94. [PMID: 19737154 DOI: 10.1111/j.1600-0404.2009.01157.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study survival and functional outcome after intracranial tumor surgery in elderly patients. MATERIALS AND METHODS This is a retrospective study of 289 consecutive patients of age > or =70 years, who underwent primary surgery (resection or biopsy) in the time period 2003-2007 for an intracranial tumor (87 astrocytomas, 79 meningiomas, 62 brain metastases, 33 pituitary adenomas and 28 other tumors). RESULTS The surgical mortality was 2.8%. Overall survival at 6 months, 1, 2 and 5 years was 73%, 57%, 46% and 38% respectively. Histology, pre-operative Eastern Cooperative Oncology Group (ECOG) performance score and resection, as opposed to biopsy, were significantly associated with survival. Gender, age and American Association of Anaesthetists (ASA) score were not significantly related to survival. One-year survival after surgery for astrocytoma, meningioma, brain metastases and pituitary adenoma were 24%, 94%, 31% and 96% respectively. More than 85% of the patients who were alive 6 months after surgery had a stable or improved ECOG score compared with their pre-operative score. CONCLUSIONS Surgery for intracranial tumors in selected elderly patients is worthwhile, not futile. Age alone should not be used as a selection criterion for treatment.
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Affiliation(s)
- S G Rogne
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Johannesen TB, Langmark F, Wesenberg F, Lote K. Prevalence of Norwegian patients diagnosed with childhood cancer, their working ability and need of health insurance benefits. Acta Oncol 2009; 46:60-6. [PMID: 17438706 DOI: 10.1080/02841860600774026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The object of this study was in a population-based material to investigate the prevalence of patients diagnosed with childhood cancer, and compared to the general population to assess working ability, yearly income and need for health insurance benefits in patients surviving at least five years after treatment for childhood CNS tumours or hematological malignancies. During the period January 1, 1970 to December 31, 2002 the prevalence in the Norwegian population of patients diagnosed with any childhood cancer increased from 12.2 (473/3 888 305) to 65.1 (2944/4 524 066) per 100 000 population. The proportion of survivors in need of any health insurance benefit was for CNS tumours 47.1% and for hematological malignancies 21.0%. The proportion in the age group 16-67 receiving disability pension for CNS tumours was 94/454 (20.7%) compared to 21/575 (3.7%) for patients treated for hematological malignancies (p < 0.001). Of patients given radiotherapy 25/70 (35.7%) received disability pension, compared to 90/959 (9.4%) in unirradiated patients, p < 0.001. Yearly income and working ability was particularly low for CNS tumour survivors. This study illustrates loss of working capability associated with pediatric cancer and treatment and long-term requirement of health insurance benefits.
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Affiliation(s)
- T B Johannesen
- Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, N-0310 Oslo, Norway.
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Affiliation(s)
- S D Fosså
- Rikshospitalet-Radiumhospitalet, Department of Clinical Cancer Research, Oslo, Norway
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Johannesen TB, Angell-Andersen E, Tretli S, Langmark F, Lote K. Trends in Incidence of Brain and Central Nervous System Tumors in Norway, 1970–1999. Neuroepidemiology 2004; 23:101-9. [PMID: 15084778 DOI: 10.1159/000075952] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate trends in the incidence of childhood and adult brain and central nervous system (CNS) tumors in Norway from 1970 through 1999. In this period, a total of 14,641 patients were diagnosed with a primary benign or malignant neoplasm of the brain and CNS. Age-adjusted incidence rates were reported together with results of loglinear regression and an age-period-cohort model based on the Poisson regression model. In children (<15 years), the proportion of brain and CNS tumors was 28.2% (1,042/3,697) of all new cancer cases compared with 2.8% in adults (13,599/492,237). The overall rate of brain and CNS tumors increased during the study period from 6.49 to 12.02 cases per 100,000 person-years. A trend of leveling off in incidence of most tumor categories during the study period was indicated with a possible continuing increase in the period 1995-1999, especially in the age group 0-4 years and in patients aged 60 years or more. Age and period together provided a satisfactory model in patients being <60 years of age and less completeness of diagnosis was found in males compared with females, possibly due to the distribution in males of more aggressive tumors.
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Affiliation(s)
- T B Johannesen
- The Norwegian Cancer Registry, Institute of Population-Based Cancer Research, Oslo, Norway.
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Abstract
Long-term survivors of neuro-epithelial brain tumours have a higher death rate compared with the general population and the aims of this study were to investigate the causes of death and analyse long-term survival using population-based material. A total of 6209 patients were registered in the period of 1970-1993 with a primary intracranial neuro-epithelial tumour in the The Norwegian Cancer Registry. In a pilot study, a high level of agreement with regard to the cause of death was found between clinical data and the registered cause of death. Underlying causes of death in the whole population were therefore analysed. Most deaths were caused by the primary neuro-epithelial brain tumour within 10 years of diagnosis. Although the numbers were small, the proportion of patients dying from other cancers, vascular disease, infections and accidents continued to rise with time. Survival was computed using the Kaplan-Meier method. For children, survival at 5, 10 and 15 years significantly improved from the time period of 1970-1981 to 1982-1993 (47.9, 43.6 and 43.3% versus 63.8, 59.8 and 59.8%, respectively, P <0.0001). Similar improvements in survival at 5, 10 and 15 years were observed for young adults aged 15-49 years (32.7, 21.3 and 16.5% versus 50.1, 37.5 and 33.1%, for the same time periods, P<0.0001). No such improvement for those aged 50 years and over was observed (corresponding figures of 6.6, 3.8 and 2.8% versus 7.7, 4.8 and 3.4%). Prognosis for those with childhood medulloblastomas improved significantly, as did the prognosis of younger adults with low-grade gliomas and unbiopsied/ unclassifiable grade gliomas.
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Affiliation(s)
- T B Johannesen
- The Norwegian Cancer Registry, Institute of Population-based Cancer Research, Montebello, N-0310, Oslo, Norway.
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Johannesen TB, Watne K, Lote K, Norum J, Hennig R, Tverå K, Hirschberg H. Intracavity fractionated balloon brachytherapy in glioblastoma. Acta Neurochir (Wien) 1999; 141:127-33. [PMID: 10189493 DOI: 10.1007/s007010050276] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In order to reduce hospitalisation time for patients receiving postoperative radiotherapy a phase I-II study of intracavity balloon brachytherapy was instituted. An indwelling balloon catheter was implanted during the closing phase of the initial operation. Starting on the second or third postoperative day the catheter was afterloaded with a high dose rate isotope via a remotely controlled afterloading system. The treatment consisted of 10-12 fractions over a period of 5-6 days, with each treatment session requiring approximately 15 minutes. No external beam radiation was given. Forty-four newly diagnosed patients were treated. A total dose of either 60 Gy (33 patients) or 72 Gy (11 patients) was given. The overall median survival was 11.7 months, (range 2.7-50.9). The treatment was well tolerated and none of the applicators were removed prematurely. The total median hospital stay for this group of patients was significantly reduced compared to more conventional protocols. This study indicates that intracavity high dose rate balloon brachytherapy can achieve survival rates equivalent to those of conventional radiotherapy and is both cost and time efficient.
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Affiliation(s)
- T B Johannesen
- Department of Oncology, University Hospital of Tromsø, Norway
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Cunningham D, Pyrhönen S, James RD, Punt CJ, Hickish TF, Heikkila R, Johannesen TB, Starkhammar H, Topham CA, Awad L, Jacques C, Herait P. Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 1998; 352:1413-8. [PMID: 9807987 DOI: 10.1016/s0140-6736(98)02309-5] [Citation(s) in RCA: 1033] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In phase II studies, irinotecan is active in metastatic colorectal cancer, but the overall benefit has not been assessed in a randomised clinical trial. METHODS Patients with proven metastatic colorectal cancer, which had progressed within 6 months of treatment with fluorouracil, were randomly assigned either 300-350 mg/m2 irinotecan every 3 weeks with supportive care or supportive care alone, in a 2:1 ratio. FINDINGS 189 patients were allocated irinotecan and supportive care and 90 supportive care alone. The mean age of the participants was 58.8 years; 181 (65%) were men and 98 (35%) were women. WHO performance status was 0 in 79 (42%) patients, 1 in 77 (41%) patients, and 2 in 32 (17%) patients. Tumour-related symptoms were present in 134 (71%) patients and weight loss of more than 5% was seen in 15 (8%) patients. With a median follow-up of 13 months, the overall survival was significantly better in the irinotecan group (p=0.0001), with 36.2% 1-year survival in the irinotecan group versus 13.8% in the supportive-care group. The survival benefit, adjusted for prognostic factors in a multivariate analysis, remained significant (p=0.001). Survival without performance-status deterioration (p=0.0001), without weight loss of more than 5% (p=0.018), and pain-free survival (p=0.003) were significantly better in the patients given irinotecan. In a quality-of-life analysis, all significant differences, except on diarrhoea score, were in favour of the irinotecan group. INTERPRETATION Our study shows that despite the side-effects of treatment, patients who have metastatic colorectal cancer, and for whom fluorouracil has failed, have a longer survival, fewer tumour-related symptoms, and a better quality of life when treated with irinotecan than with supportive care alone.
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