A case for the worldwide collection of primary benign brain tumors

Central Nervous System Neoplasms in Hong Kong: An Inscription of Local Studies

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A registry of brain and central nervous system (CNS) tumor patients in Hong Kong comprising of data from both public and private neurosurgical practices (with approximately 98% patients of Chinese origin), suggested geographical or racial variations in disease incidence. The data confers the finding of a comparatively lower incidence rate of meningioma and malignant gliomas as in other parts of Southeast Asia.

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With data suggesting epidemiological difference, the treatment response, particularly in highgrade glioma, was studied. Patients suffering from glioblastoma (GBM) in Hong Kong received the standard of care, which involves safe, maximal resection followed by the Stupp regime. 5-aminolevulinic acid (5-ALA)-based fluorescence-guided surgery was found to be feasible and safe to adopt in the treatment of local WHO Grade III & IV gliomas patients. Survival benefit was seen in a group of patients using extended adjuvant temozolomide (TMZ) treatment for newly diagnosed GBM as compared to those treated with the standard 6 cycles. Salvage therapies with either single agent bevacizumab or bevacizumab plus irinotecan appeared to be effective treatment options in Hong Kong patients with recurrent malignant glioma, with a good associated 6- month progression-free survival (PFS) rate which was comparable to previously published overseas data in this disease type in the same overall population.

A population based perspective on children and youth with brain tumours

BACKGROUND

There is currently no active surveillance of metastatic and non-malignant brain tumours in Canada as well as data on the health service use of children and youth with brain tumours. The objective of this study was to identify pediatric primary, metastatic, benign, and unspecified brain tumours in Ontario, Canada and to describe their health service use from a population based perspective.

METHODS

The population based healthcare administrative databases National Ambulatory Care Reporting System and the Discharge Abstract Database were used. Patients with malignant (primary and metastatic), benign, and unspecified brain tumours in acute care between fiscal year 2003/04 and 2009/10 were identified using specified International Classification of Diseases version ten codes.

RESULTS

Between fiscal year 2003/04 and 2009/10, there were 4022 brain tumour episodes of care (18.4 per 100,000 children and youth). Malignant brain tumors had the highest rates of episodes of care (14.9 times higher than that of benign and 5.7 times higher than that of unspecified brain tumours). Compared to patients with malignant brain tumours, those with benign brain tumours spent a longer period of time in acute care (p < .05) and patients with unspecified brain tumours stayed in the intensive care units for a longer period of time (p < .0001) with a lower proportion were discharged home (p < .0001).

CONCLUSION

Despite higher rates of malignant brain tumour episodes of care, patients with benign and unspecified brain tumours also use acute care services and post-acute services that are currently not taken into account in healthcare planning and resource allocation. Active surveillance and research of metastatic and non-malignant brain tumours that can inform the planning of healthcare services and resource allocation for this population is encouraged.

Relative survival of patients with non-malignant central nervous system tumours: a descriptive study by the Austrian Brain Tumour Registry

BACKGROUND

Unlike malignant primary central nervous system (CNS) tumours outcome data on non-malignant CNS tumours are scarce. For patients diagnosed from 1996 to 2002 5-year relative survival of only 85.0% has been reported. We investigated this rate in a contemporary patient cohort to update information on survival.

METHODS

We followed a cohort of 3983 cases within the Austrian Brain Tumour Registry. All patients were newly diagnosed from 2005 to 2010 with a histologically confirmed non-malignant CNS tumour. Vital status, cause of death, and population life tables were obtained by 31 December 2011 to calculate relative survival.

RESULTS

Overall 5-year relative survival was 96.1% (95% CI 95.1-97.1%), being significantly lower in tumours of borderline (90.2%, 87.2-92.7%) than benign behaviour (97.4%, 96.3-98.3%). Benign tumour survival ranged from 86.8 for neurofibroma to 99.7% for Schwannoma; for borderline tumours survival rates varied from 83.2 for haemangiopericytoma to 98.4% for myxopapillary ependymoma. Cause of death was directly attributed to the CNS tumour in 39.6%, followed by other cancer (20.4%) and cardiovascular disease (15.8%).

CONCLUSION

The overall excess mortality in patients with non-malignant CNS tumours is 5.5%, indicating a significant improvement in survival over the last decade. Still, the remaining adverse impact on survival underpins the importance of systematic registration of these tumours.

Overexpression of s6 kinase 1 in brain tumours is associated with induction of hypoxia-responsive genes and predicts patients' survival

mTOR/S6K pathway is a crucial regulator of cell growth and metabolism. Deregulated signalling via S6K has been linked to various human pathologies, including metabolic disorders and cancer. Many of the molecules signalling upstream of S6K have been shown to be either mutated or overexpressed in tumours, leading to S6K activation. The role of S6K1 in brain tumours is not fully investigated. In this study, we investigated the gene expression profile of S6 kinases in brain and CNS tumours using the publically available Cancer Microarray Database. We found that S6K1 but not S6K2 gene is overexpressed in brain tumours and this upregulation is associated with patients' poor survival. Furthermore, we interrogated Oncomine database for the expression profile of hypoxia-induced genes using a literature-defined concept. This gene list included HIF1A, VEGFA, SOX4, SOX9, MMP2, and NEDD9. We show that those genes are upregulated in all brain tumour studies investigated. Additionally, we analysed the coexpression profile of S6K1 and hypoxia responsive genes. The analysis was done across 4 different brain studies and showed that S6K1 is co-overexpressed with several hypoxia responsive genes. This study highlights the possible role of S6K1 in brain tumour progression and prediction of patients' survival. However, new epidemiological studies should be conducted in order to confirm these associations and to refine the role of S6K1 in brain tumours as a useful marker for patients' survival.

Intracranial tumors in Kuwait: a 15-year survey

The dearth of literature on intracranial tumors (ICT) in Kuwait has necessitated this study whose objective is epidemiological. It is based on the records of the Department of Pathology, Al-Sabah Hospital, Kuwait, where virtually all brain biopsies in Kuwait were examined. Between 1995 and 2009, 439 males (53.41%) and 383 females (46.59%) had primary intracranial tumors (PICT). Most (69%) were younger than 50 years, with 16% children and adolescents and 4% elderly (≥70 years); meningioma (28%), pituitary adenoma (19%), glioblastoma (15%), astrocytoma (13%), and medulloblastoma (5%) were the most common. In childhood and adolescence, astrocytoma (35.34%) and medulloblastoma (22.56%) predominated. The mean age-adjusted incidence rate/100,000 was: PICT: 3.02; astrocytic tumors: 0.93; meningioma: 0.96; pituitary adenoma: 0.44; and medulloblastoma: 0.13. All showed a declining trend which was only statistically significant for medulloblastoma (P = 0.007). A modest correlation between the percentage of elderly in the general population and incidence rates was found (r = 0.411). Tumors with significant male preponderance were high-grade astrocytic tumors, silent pituitary adenoma (SA), and nerve sheath tumor. Meningioma had a female to male ratio of 2.24. The peak frequency for functional pituitary adenoma and females was in the age range of 20-29 years, while for SA and males it was 40-49 years. About 5% of ICT were metastatic, with cancers of breast (26%), lung (17%) and gastrointestinal (11%) origin as the most common. In conclusion, the epidemiology of PICT in Kuwait is characterized by low incidence rates and a distinct age distribution.