Neuro-Oncology

Brain Tumor Frequency

• MC intracranial tumors: Brain Metastases (just over 50%).
• Incidence of primary brain tumors: approximately 20-30 per 100,000 in adults and 5 per 100,000 in children.
• About one third of primary brain tumors in adults are malignant, whereas they account for two thirds in childhood.
• Frequency of WHO subgroups and specific tumors is given (information not provided in the text).

Commonest Primary Brain Tumors by WHO Group	Commonest Primary Brain Tumors by Subtype
Meninges (37.6%) Neuroepithelial tissue (29.9%) Sellar region (16.3%) Cranial and spinal nerves (8.1%) Unclassified (5.6%) Lymphoma and hematopoietic (2.1%) Germ cell tumors and cysts (0.4%)	Meningioma (36%) Pituitary tumors (15.5%) Glioblastoma multiforme (15.1%) Nerve sheath tumors (8.1%) Diffuse astrocytoma (2.3%) Primary CNS lymphoma (2%) Ependymal (1.9%) Anaplastic astrocytoma (1.7%) Pilocytic astrocytoma (1.4%) Neuronal and neuronal mixed (1.2%) Oligodendroglioma (1.1%) Oligoastrocytoma (0.9%) Craniopharyngioma (0.8%) Anaplastic oligodendroglioma (0.5%)

Performance Scales

Karnofsky Performance Scale

Score	Description
100	Normal; no complaints, no signs of disease
90	Capable of normal activity, minor symptoms or signs of disease
80	Normal activity with some difficulty, some symptoms or signs
70	Caring for self, not capable of normal activity or work
60	Requiring some help, can take care of most personal requirements
50	Requires help often, requires frequent medical care
40	Disabled, requires special care and help
30	Severely disabled, hospital admission required but no imminent risk of death
20	Very ill, urgently requiring admission, requires supportive measures or treatment
10	Moribund, rapidly progressive fatal disease processes
0	Dead

Recursive partitioning analysis (RPA)

RPA class	Description	Median survival (mos)
1	KPS ≥70 and age < 65 yrs controlled or absent primary tumor w/ the brain the only site of metastasis	7
2	all others (i.e., not RPA class 1 or 3)	4
3	KPS <70	2

ECOG Performance Scale

Score	Description
0	Asymptomatic (fully active, able to carry on all predisease activities without restriction)
1	Symptomatic but completely ambulatory (restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature)
2	Symptomatic, <50% in bed during waking hours (ambulatory and capable of all self-care but unable to carry out any work activities)
3	Symptomatic, >50% in bed during waking hours, but not bedbound (capable of limited self-care)
4	Bedbound (completely disabled; cannot carry on any self-care; totally confined to bed or chair)
5	Dead