A data of 214 patients of Primary central nervous system tumors was retrospectively analyzed from January 2011 to December 2016. Age ranged from 4years to 72 years. Median age was 36 years. Out of 214 patients, males (n=154, 71.9%) outnumbered females (n= 60,28.03%) (Fig 1). M: F ratio was found to be 3.85:1.5. Most common tumor in our audit were neuroepithelial tumor (n=180, 84%). Glioblastoma Multiforme constituted 33.1% of cases (n=71). The second most frequent group was embryonal tumor, consisting of medulloblastoma which was commonest in pediatric age group (n=14,6.5%) (Table 2). The most common symptom was headache (51.4%) followed by Seizures (25.2%) (Table 3). CECT brain was done in 89.71%, while MRI brain was done in 10.28% patients. According to the sites, frontal lobe was the commonest site of involvement. Surgical procedure consisted of excision in 37.3% followed by decompression in 24.7% (Table 4). 135 (63-08%) received radiotherapy while 68(31.7%) defaulted for radiotherapy. Chemotherapy (capsule temozolomide) was given to 37(17.2%) as concurrent chemoradiotherapy and adjuvant therapy mostly in Grade 3-4 gliomas. 35(16.3%) patients received as concurrent regimen, and 2(0.9%) patients as adjuvant treatment. 69(32.2%) patients didn’t received chemotherapy (defaulted for chemotherapy). At median follow up of 8 months out of 214 patients, 46 (2.4%) were available for analysis. Out of 46, 12(26%) were of Glioblastoma Multiforme, 12(26%) Grade III astrocytoma, 7(3.2%) Grade II astrocytoma, 5(10.8%) Grade III oligodendroglioma, 2(4.3%) medulloblastoma, 2(4.3%) gliosarcoma, 2(4.3%) grade II oligodendroglioma and 1(2.1%) each of grade III ependymoma, pilocytic astrocytoma and grade III meningioma. Also, males (89.1%) were found to be more common than females (10.8%) for analysis during follow-up. Out of 46 (21.4%), recurrence was seen in 11(23.9%) and 38 (82.6%) were found to be disease free at 8-month follow-up period. Recurrence was seen in 8(72.7%) cases of Glioblastoma multiforme and in 1 (9.09%) each of Gliosarcoma and grade II & III astrocytoma. Salvage treatment consisted of surgery in 3(27.27%) and chemotherapy in 8(72.7%) cases. 100(46.7%) cases were not available for analysis at follow-up of 8 months. Out of 100 (46.72%), 11(11%) defaulted during treatment, 89 (89%) completed radiotherapy but were unable for analysis at a follow up of 8 months. 68(31.7%) defaulted for treatment itself after first visit. The probable reason for default could be long waiting time of radiotherapy dates, illiteracy, long distant patients and ignorance.

Fig 1-Male & Female distribution

Fig 2- Age wise distribution of brain tumor patients

Table1-Patient characteristics of Primary central nervous tumor patients

Table 2- Distribution of Primary CNS tumors with histologic subtypes

Table 3- Clinical Presentation of Primary CNS tumors

Table 4- Surgical procedures in Primary CNS tumors

Brain tumors are heterogeneous group of neoplasm accounting for less than 2% of all malignant neoplasms [1]. They constitute 1.9% of all tumors in India [2]. Bimodal age distribution with a peak at childhood and second peak at 45-70 years is seen [3]. The age adjusted incidence rate of central nervous system tumor during 1988-2003 showed increase in incidence from 0.5 to 2.4 for male and 0.5 to 1.1 for females as per Bhopal Cancer registry in India [4]. Among 214 cases of Primary central nervous tumor in our study we found that the patient’s age ranged from 4 to 72 years with a peak between 20 and 40 years. Our finding was similar to the findings of Krishnatreya M et al [5]. The median age was found to be 36 years which is comparable to the study done by Jalali and Datta [6], which was found to be lower than the developed countries [7, 8]. Males were more commonly affected than females which was comparable to study done by Jalali and Datta [6]. Neuroepithelial tumors were the most common tumor (n=180, 84%), glioblastoma multiforme being the most common subtype (n=71, 33%). Our findings support studies from other countries which also showed that the most common central nervous system tumors were astrocytoma in United States (49%) [11], Germany (41.7%) [12], Croatia (58.3%) [13] and from India Dastur and Lalitha et al [14], Dhar et al [9], Aryal et al [10] and by Dasgupta [15]. Glioblastoma multiforme was the most common subtype (n=71, 33%) followed by diffuse infiltrating astrocytoma which is nearly same as seen in literature [16,17,18,19]. We didn’t get the cases of meningiomas (n=10, 4.6%) frequently, as they are benign and surgery is the main treatment modality. Radiotherapy is required when the histology is of higher grade, in case of recurrence and if surgery is not feasible. The most common symptom in our study was headache which was found to be similar to other studies [3, 20]. We found frontal lobe as the most common site of brain tumor in our study, which was similar to the findings of Masoodi et al and Jalali et al [3, 6]. Most of the cases are referred from the neurosurgery department and majority are operated so the most common surgical procedure done was excision (37.3%), followed by decompression (24.7%) (Table:4). Out of 214 patients, 135(68.08%) received radiotherapy which were grade III, grade IV tumors, while 68(31.7%) defaulted for treatment (mainly grade 1, grade II tumors). Chemotherapy in the form of capsule temozolomide was given to 37(17.2%) patients as concurrent and adjuvant therapy (mostly in Grade III-IV gliomas). While 35(16.3%) patients received as concurrent regimen, and 2(0.9%) patients as only adjuvant treatment. 69(32.2%) patients didn’t received chemotherapy (defaulted for chemotherapy). The percentage of patient defaulting for radiotherapy is high (21.9%) in our study. It reflects illiteracy, lacunae in our follow-up practice and long waiting periods of radiotherapy dates.