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)

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.

[Organizational model and clinical evaluation in Day Surgery: our experience]

Surgical treatments in Day Surgery (DS) are characterised by limited hospitalisation during daytime on the base of an organizational model established by appropriate protocols. According to it, the patient at low operational risk and the patient whose post-operative management is easy is admitted to the programme. The Authors report their experience of DS focusing on the surgical and anaesthesiological qualifications that help to control the risk factors reducing the complications and thus guaranteeing the safety and effectiveness of the service.

Treatment of pilonidal disease in short-stay surgery: personal method

HYPOTHESIS

We state that our personal method constitued by excision and primary closure in the treatment of pilonidal sinus, is able to obtain a low rate of recurrence and a fast return to work.

PATIENTS AND METHODS

Our report has been conducted on 315 patients. Excision and primary closure in the treatment of pilonidal sinus by local-regional anesthesia. The patients have been discharged on second day.

RESULTS

We have not had intraoperative complication; about morbilità there have been 4% of seromas treated conservatively.

CONCLUSIONS

With this personal method we have obtained very good results, in short and long time, with less of recurrences and fast return to work.

Multiple treatment of gas gangrene at a rare anatomic location. Case report

The authors report a clinical case of gas gangrene in a rare anatomic location in a 79-year-old woman, admitted because 3 days earlier she had developed a painful swelling with erythematous cutis in her right iliac fossa and suffered from a seriously increasing fever. The physical examination showed a large area of gas gangrene. In accordance with international literature, excellent results have been obtained by adopting an early multiple therapy (including surgical debridement, intensive therapy, antibiotic treatment and hyperbaric oxygen treatment).

Continuous spinal analgesia by means of micropumps[correction of micropumpus]: a report of 163 chronic pain patients

Chronic pain in patients suffering from advanced cancer as well as unbearable chronic pain states depending on non-malignant pathology have always represented a test bench to verify results of advanced therapeutical programs as to more traditional approaches. The Authors present their experience resulting from longterm spinal infusion with peridural catheters connected to portable micropumps for the continuous administration of analgesic solutions. The availability of portable micropumps, a better understanding of spinal opioid receptors and advances in pharmacokinetics of opiate analgesics led in these years to a tremendous improvement of pain control possibilities and of the quality of life of patients.

[Clinical usefulness of dexamethasone test in depression]

The paper stresses the importance of the dexamethasone suppression test in the diagnosis of severe depression (major psychiatric disorders). For some decades researchers have been aware of the importance of the hypothalamus-pituitary-adrenal gland axis in the physiological response to stress, and likewise the importance of possible correlations between emotional and biological factors in psychiatric disorders. Several studies have sustained that in major psychiatric disorders, and in particular in depression, not only is there a hypersecretion of cortisol, but also a resistance to the suppression of cortisol secretion which normally follows the injection of an exogenous steroid, for example dexamethasone. This laboratory test is therefore of value both for diagnostic purposes and for identifying severe depression from other morbid conditions; it may also be usefully employed for prognostic and therapeutic purposes.

[The role of opioid antagonists in the treatment of obesity. Results of a clinical trial with naltrexone]

On the basis of literature data relative to the alteration of beta-endorphin tone in obese subjects, we conducted a clinical trial employing Naltrexone (a receptorial antagonist of endogen opioids) in order to evaluate its efficacy in increasing the compliance of these subjects on dietary treatment. The drug dosage was 50 mg/daily (100 mg/die). The clinical study was carried out following the double-blind crossover method for a period of 4 months in a group of 17 obese subjects who also underwent to psychodiagnostic interviews. Significant weight reduction was observed in the 9 patients who carried out the treatment by assuming Naltrexone (kg 4.00 +/- 3.97) rather than with placebo (kg 0.96 +/- 4.95). The drug was subjectively well tolerated and it did not alter the endocrine, metabolic, psychometric, and cardiovascular monitored parameters. The insulin secretion during OGTT did not show significant alterations. Our data emphasize the Naltrexone efficacy in improving the compliance of the obese subjects during dietary treatment.

[Psychometric evaluations in a group of obese patients]

Several reported cases point out significant alterations in the psychologic profile of obese subjects and the utility of a psychotherapeutic support to the dietetic or pharmacological therapy. Each patient underwent a psychodiagnostic interview and the following rating-scales were applied: QPF (Psychophysiological Test); STAI X-1 and X-2 (State and Trait Anxiety Inventory); Hamilton-D (Depression); ZUNG (Self-administered Depression Test); TSR (Reaction Schemes Test). We observed an increase in the answer of the blocked projection (in the 40% of subjects), of negation (26.6%), of guilt (13.3%), a decrease in the projection answer (33.3%), high scores of QPF (21%). The STAI, the Hamilton, and the Zung were altered in the 10% of the examined subjects. Our data emphasize the importance of an individual psychotherapeutic support in a subgroup of obese subjects.

High-dose etoposide and autologous bone marrow transplantation as intensification treatment in small cell lung cancer: a pilot study

A pilot study was conducted in which 15 patients with small cell lung cancer (SCLC) with limited or extended disease were treated with high dose etoposide (600 mg/m2 daily for 3 consecutive days) followed by autologous bone marrow transplantation (ABMT). Twelve patients underwent a double graft. All had achieved complete or partial remission with conventional induction chemotherapy (adriamycin and etoposide, plus cisplatin in five cases). After ABMT six of the 15 patients did not receive radiotherapy to the chest; all but four patients received prophylactic brain irradiation. No toxic deaths were recorded during the period of aplasia. Eleven patients relapsed and died after ABMT. The median time to death was 18 months. One other patient died at 13 months of unknown cause. At the present time three patients are alive and free of disease at 54, 51 and 47 months respectively. This pilot study shows that high dose etoposide and ABMT is well tolerated as late intensification for responsive SCLC. Definite conclusions about its precise role in therapy cannot yet be drawn.