The Evangelismos hospital central nervous system tumor registry: Analysis of 1414 cases (1998-2009)

A Comparison of Epidemiological Characteristics of Central Nervous System Tumours in China and Globally from 1990 to 2019

BACKGROUND

Despite their great disease burden, there have been few studies on the epidemiology of central nervous system tumours (CNSTs) in China. We used the latest data updated by GBD to analyse the trends of incidence, mortality, and disability-adjusted life years (DALYs) for CNSTs in China versus globally.

METHODS

Epidemiological data on CNSTs were extracted from GBD 2019. We used Joinpoint regression analysis to calculate the magnitude and direction of the trends and the age-period-cohort method to analyse the age, period, and cohort effects of the trend.

RESULTS

From 1990 to 2019, the 106.52% increase in Chinese incident cases was higher than the global increase (94.35%). The 67.32% increase in cancer deaths and 16.03% increase in DALYs were lower than the global increases (cancer death: 76.36%; DALYs: 40.06%). The age-standardized incidence rates (ASIRs) in China were higher than the global ASIRs, and the increase in China was higher than that globally. Although the age-standardized mortality rates and age-standardized DALY rates in China were higher, their increases in China were less than those globally. Both in China and globally, the number and incidence, mortality, and DALYs by age group showed a bimodal distribution (younger than 5 years and older), and the peak in the older age group showed a backwards trend. The proportion of incident cases, cancer deaths, and DALYs also increased in the older age group. In the age-period-cohort model, the local drifts in the older age group were above zero.

CONCLUSIONS

The burden of CNSTs is very serious in China, and we should pay attention to the key populations, early diagnosis technology, improvements in medical technology, and ways to reduce medical costs. We believe our results could help policymakers allocate resources efficiently to reduce the burden of CNSTs.

[Prevalence of central nervous system tumours and histological identification in the operated patient: 20 years of experience]

BACKGROUND

Central nervous system tumours comprise a heterogeneous group of neoplasms with great histological diversity. Despite the rising prevalence of these tumours in developing countries, some places like Mexico and Latin America have no representative studies that show the real impact of these tumours in our population.

OBJECTIVE

To describe the characteristics of the primary and secondary tumours of the central nervous system in the last 20 years in a Mexican institution.

MATERIAL AND METHODS

Patients with histopathological diagnosis from 1993 to 2013 in our institution, grouping them according to WHO classification 2007, characterising them by age group, gender, and anatomical location.

RESULTS

There were a total of 511 tumours of the central nervous system. Of those, 292 were women and 219 men, with a ratio 1.3: 1, and a mean age of 49.3 years. Tumours with higher prevalence were: Meningeal tumours, 171 (33%), followed by neuroepithelial, 121 (24%). Astrocytoma had the highest prevalence in paediatric patients, whereas in those older than 20 years it was the meningioma. The supratentorial location was the most involved.

CONCLUSION

This is the first study of a series of cases in Mexico that is performed by taking into account benign and malignant tumours of the central nervous system, with patients of all age groups with a range of 20 years. While this work only represents a retrospective analysis of an institution, it can be a strong indication of the epidemiology of these tumours in our environment.

Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO Working Group on Stereotactic Radiotherapy

BACKGROUND

This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate.

RESULTS AND DISCUSSION

The main recommendations are: Patients with solid tumors except germ cell tumors and small-cell lung cancer with a life expectancy of more than 3 months suffering from a single brain metastasis of less than 3 cm in diameter should be considered for SRS. Especially when metastases are not amenable to surgery, are located in the brain stem, and have no mass effect, SRS should be offered to the patient. For multiple (two to four) metastases--all less than 2.5 cm in diameter--in patients with a life expectancy of more than 3 months, SRS should be used rather than whole-brain radiotherapy (WBRT). Adjuvant WBRT after SRS for both single and multiple (two to four) metastases increases local control and reduces the frequency of distant brain metastases, but does not prolong survival when compared with SRS and salvage treatment. As WBRT carries the risk of inducing neurocognitive damage, it seems reasonable to withhold WBRT for as long as possible.

CONCLUSION

A single (marginal) dose of 20 Gy is a reasonable choice that balances the effect on the treated lesion (local control, partial remission) against the risk of late side effects (radionecrosis). Higher doses (22-25 Gy) may be used for smaller (< 1 cm) lesions, while a dose reduction to 18 Gy may be necessary for lesions greater than 2.5-3 cm. As the infiltration zone of the brain metastases is usually small, the GTV-CTV (gross tumor volume-clinical target volume) margin should be in the range of 0-1 mm. The CTV-PTV (planning target volume) margin depends on the treatment technique and should lie in the range of 0-2 mm. Distant brain recurrences fulfilling the aforementioned criteria can be treated with SRS irrespective of previous WBRT.