神経感染症

抽象的な

Differentiation of Epidemiology and Issues in Neuro-Oncology between the East and the West Challenges and Openings

Nischal Acharya

Although excrescences of the brain and central nervous system (CNS) are fairly uncommon, comprising only 1 -2 of the overall cancer burden, they represent a substantial source of morbidity and mortality worldwide. The age- shaped periodic frequency of CNS tumours is reportedly low; still, there is substantial global variability in its frequency, with nearly five-fold difference between regions with the topmost rates in developed countries in the West and those with the lowest rates in developing countries in South- East Asia, including India, possibly attributable to pivotal differences in environmental factors, heritable vulnerability and cultural practices, as well as resource constraints in low – middle income countries precluding precise ascertainment and accurate opinion. The burden of CNS tumours is further compounded by the fact that they bear largely specialised and professed multidisciplinary care, including access to modern neuroimaging, neurosurgery, neuropathology and molecular biology, radiotherapy, chemotherapy and rehabilitation services, which may not be considerably available in an integrated manner in large corridor of the world with a large variation in clinical- uniformity of care and attendant diversity in clinical issues. CNS tumours encompass a eclectic spectrum of histopathological realities with differences in donation, distinct molecular/ heritable differences, different natural behavior and varying clinical issues. Survival is largely dependent on histology, grade and molecular biology, but varies considerably across landmasses, indeed for the same tumour type and grade. In general, survival is advanced in children with primary brain tumours than in grown- ups, largely due to the differences in histological distribution across age groups. Still, there is wide variability, with 5- time survival for paediatric brain tumours being< 40 in some low – middle income countries compared with 70 – 80 in the advanced world. This review compares the descriptive epidemiology and clinical issues of primary brain tumours between the East and the West that pose unique challenges but also give new openings in contemporary neuro- oncological practice.