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Hainfellner A, Borkovec M, Seebrecht L, Neuhauser M, Roetzer-Pejrimovsky T, Greutter L, Surböck B, Hager-Seifert A, Gorka-Vom Hof D, Urbanic-Purkart T, Stultschnig M, Cijan C, Würtz F, Calabek-Wohinz B, Pichler J, Höllmüller I, Leibetseder A, Weis S, Kleindienst W, Seiberl M, Bieler L, Hecker C, Schwartz C, Iglseder S, Heugenhauser J, Nowosielski M, Thomé C, Moser P, Hoffermann M, Loibnegger K, Dieckmann K, Tomschik M, Widhalm G, Rössler K, Marosi C, Wöhrer A, Hainfellner JA, Oberndorfer S. Glioblastoma in the real-world setting: patterns of care and outcome in the Austrian population. J Neurooncol 2024:10.1007/s11060-024-04808-x. [PMID: 39192069 DOI: 10.1007/s11060-024-04808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE We present results of a retrospective population-based investigation of patterns of care and outcome of glioblastoma patients in Austria. PATIENTS AND METHODS In this nation-wide cooperative project, all Austrian glioblastoma patients newly diagnosed between 2014 and 2018 and registered in the ABTR-SANOnet database were included. Histological typing used criteria of the WHO classification of CNS tumors, 4th edition 2016. Patterns of care were assessed, and all patients were followed until the end of 2019. RESULTS 1,420 adult glioblastoma cases were identified. 813 (57.3%) patients were male and 607 (42.7%) female. Median age at diagnosis was 64 years (range: 18-88). Median overall survival (OS) was 11.6 months in the total cohort and 10.9 months in patients with proven IDH-wildtype. Median OS in the patient group ≤ 65 years receiving postoperative standard of care therapy was 16.1 months. In the patient group > 65 years with postoperative therapy, median OS was 11.2 months. Follow-up ≥ 5 years identified 13/264 (4.9%) long-term survivors. Brain tumor surgery frequently was assisted by 5-aminolevulinic acid (5-ALA) fluorescence (up to 55%). Postoperative treatment was initiated around one month after surgery (median: 31 days) following standardized protocols in 1,041/1,420 (73.3%) cases. In 830 patients (58.5%), concomitant radiochemotherapy was started according to the established standard of care. Treatment in case of progressive disease was considerably variable. 170/1,420 patients (12.0%) underwent a second surgical procedure, 467 (33.0%) received systemic treatment after progression, and 173 (12.2%) were re-irradiated. CONCLUSION Our data illustrate and confirm nation-wide translation of effective standard of care to Austrian glioblastoma patients in the recent past. In the case of progressive disease, highly variable therapeutic approaches were used, most frequently accompanied by anti-angiogenic therapy. Long-term survival was observed in a minor proportion of mostly younger patients who typically had gross total tumor resection, a favorable postoperative ECOG score, and standard of care therapy.
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Affiliation(s)
- Andreas Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
| | - Martin Borkovec
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lukas Seebrecht
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Magdalena Neuhauser
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Roetzer-Pejrimovsky
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lisa Greutter
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Birgit Surböck
- Department of Neurology, Clinic Favoriten, Vienna, Austria
| | | | | | | | | | - Clemens Cijan
- Department of Neurology, State Hospital Klagenfurt, Klagenfurt, Austria
| | - Franz Würtz
- Department of Pathology, State Hospital Klagenfurt, Klagenfurt, Austria
| | | | - Josef Pichler
- Department of Internal Medicine and Neuro-Oncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Isolde Höllmüller
- Department of Internal Medicine and Neuro-Oncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Annette Leibetseder
- Department of Neurology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Linz, Austria
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital, and Clinical Research Institute for Neurosciences, Johannes Kepler University of Linz, Linz, Austria
| | - Waltraud Kleindienst
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Seiberl
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lara Bieler
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Constantin Hecker
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sarah Iglseder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Martha Nowosielski
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrizia Moser
- Laboratory of Neuropathology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Markus Hoffermann
- Department of Neurosurgery, State Hospital Feldkirch, Feldkirch, Austria
| | - Karin Loibnegger
- Department of Radiation Oncology, State Hospital Feldkirch, Feldkirch, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurosurgery, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Division of Palliative Care, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Division of Oncology, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Medical University Campus AKH 4J, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Hospital St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Austria.
- Karl Landsteiner Institute for Clinical Neurology and Neuropsychology, Department of Neurology, University Hospital St. Pölten, St. Pölten, Austria.
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Karalexi MA, Dessypris N, Georgakis MK, Ryzhov A, Jakab Z, Zborovskaya A, Dimitrova N, Zivkovic S, Trojanowski M, Sekerija M, Antunes L, Zagar T, Eser S, Bastos J, Demetriou A, Agius D, Coza D, Gheorghiu R, Kantzanou M, Ntzani EE, Petridou ET. Birth seasonality of childhood central nervous system tumors: Analysis of primary data from 16 Southern-Eastern European population-based registries. Int J Cancer 2020; 147:1252-1263. [PMID: 31957026 DOI: 10.1002/ijc.32875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022]
Abstract
Season of birth, a surrogate of seasonal variation of environmental exposures, has been associated with increased risk of several cancers. In the context of a Southern-Eastern Europe (SEE) consortium, we explored the potential association of birth seasonality with childhood (0-14 years) central nervous system (CNS) tumors. Primary CNS tumor cases (n = 6,014) were retrieved from 16 population-based SEE registries (1983-2015). Poisson regression and meta-analyses on birth season were performed in nine countries with available live birth data (n = 4,987). Subanalyses by birth month, age, gender and principal histology were also conducted. Children born during winter were at a slightly increased risk of developing a CNS tumor overall [incidence rate ratio (IRR): 1.06, 95% confidence intervals (CI): 0.99-1.14], and of embryonal histology specifically (IRR: 1.13, 95% CI: 1.01-1.27). The winter peak of embryonal tumors was higher among boys (IRR: 1.24, 95% CI: 1.05-1.46), especially during the first 4 years of life (IRR: 1.33, 95% CI: 1.03-1.71). In contrast, boys <5 years born during summer seemed to be at a lower risk of embryonal tumors (IRR: 0.73, 95% CI: 0.54-0.99). A clustering of astrocytomas was also found among girls (0-14 years) born during spring (IRR: 1.23, 95% CI: 1.03-1.46). Although the present exploratory results are by no means definitive, they provide some indications for age-, gender- and histology-related seasonal variations of CNS tumors. Expansion of registration and linkage with cytogenetic reports could refine if birth seasonality is causally associated with CNS tumors and shed light into the complex pathophysiology of this lethal disease.
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Affiliation(s)
- Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Cancer Institute & Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Zsuzsanna Jakab
- OGYR, Hun Childhood Cancer Registry, Semmelweis University, Budapest, Hungary
| | - Anna Zborovskaya
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Childhood Cancer Sub-registry of Belarus, Minsk, Belarus
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria
| | - Snezana Zivkovic
- Central Serbia Cancer Registry, Institute of Public Health of Serbia, Belgrade, Serbia
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Center, Poznan, Poland
| | - Mario Sekerija
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia.,Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Tina Zagar
- Cancer Registry of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Ankara, Turkey
| | - Joana Bastos
- Registo Oncológico Regional do Centro (ROR-Centro), Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, Portugal
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | - Domenic Agius
- Department for Policy in Health Information and Research, Malta National Cancer Registry, Pieta, Malta
| | - Daniela Coza
- Cluj Regional Cancer Registry, The Oncology Institute "Prof. Dr. Ion Chiricuţă", Cluj-Napoca, Romania
| | - Raluca Gheorghiu
- Regional Cancer Registry, National Institute of Public Health, Iasi, Romania
| | | | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.,Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
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