A large, pan-European study has provided the clearest and most clinically relevant picture to date of survival outcomes for children with brain tumors. Led by researchers at the Princess Máxima Center for Pediatric Oncology in the Netherlands and published in The Lancet Oncology, the study analyzed data from over 30,000 children across 31 European countries. The findings offer key insights into long-term survival, cure rates, and variations between countries.

The study draws on data from EUROCARE-6, the sixth cycle of the European Cancer Registry-based Study on Survival and Care of Cancer Patients. The EUROCARE project was established in the early 1990s with the goal of systematically measuring and comparing cancer survival across European countries. EUROCARE-6, the most recent phase, includes cancer diagnoses made from 2000 onward and provides expanded coverage of the European population—over 85% for pediatric cancers—through data contributed by 80 cancer registries in 31 countries.

Modernizing data to reflect clinical reality

Childhood brain tumors are the most common solid tumors in children and a leading cause of cancer-related death. However, comparing survival rates across countries has long been a challenge due to differences in tumor classification and cancer registry methods. Many previous studies relied on the International Classification of Diseases for Oncology (ICD-O) behavior codes, which do not adequately capture the complexity of pediatric brain tumors.

To address this limitation, the research team restructured tumor categories within the EUROCARE-6 database to better align with current clinical practice. This allowed for more meaningful groupings of tumors, based on how pediatric neuro-oncologists actually diagnose and treat them.

“We restructured the tumor categories in the cancer registries to match how tumors are diagnosed today,” said Raoull Hoogendijk, PhD, a researcher who contributed to the study. “That means the numbers now align much better with clinical reality, and doctors can use them more effectively to compare outcomes.”

The study focused on the four most common pediatric central nervous system (CNS) tumors: low-grade gliomas, high-grade gliomas, ependymomas, and medulloblastomas.

Survival data were reported for diagnoses made between 1998 and 2013. The researchers estimated 1-, 3-, and 5-year survival rates, as well as the proportion of children considered “cured”—defined as those who experience no tumor-related death after a sufficient follow-up period. The study also provided projections of 10-year and 15-year survival using advanced statistical modeling.

Key findings on survival and cure rates

For the period 2008–2013, the study found notable differences in survival across tumor types:

• Low-grade gliomas had the most favorable outcomes, with a five-year observed survival rate of 92%. Long-term survival was also high, with estimated 10-year and 15-year survival rates of 90.6% and 88.5%, respectively.
• Ependymomas showed a five-year survival of 72%, and the largest absolute improvement in cure fraction—from 65% in 1998–2001 to 79% in 2010–2013.
• Medulloblastomas had a five-year survival rate of 64%, and a modest increase in cure fraction from 52% to 56% over the study period.
• High-grade gliomas, the most aggressive type, had the poorest outcomes. Overall five-year survival was just 47% and dropped to 24% when excluding tumors with unclassified pathology. Cure fractions for these tumors rose only slightly, from 14% to 20%.

“These insights help us refine treatment approaches and adjust follow-up strategies,” said Eelco Hoving, MD, PhD, Clinical Director of Neuro-oncology and pediatric neurosurgeon who also worked on the study. “This study shows that survival rates for children with brain tumors have improved over the past 15 years. But survival for children with high-grade gliomas remains far too low. Our findings highlight the urgent need for better treatments for these—and all—children with brain tumors.”

Small differences between countries

One encouraging takeaway is that the differences in survival outcomes between European countries were smaller than previously assumed. This suggests that, overall, children across Europe have fairly equitable access to effective treatments and care. For example, survival rates in the Netherlands were close to the European average.

“This study shows us where we stand in Europe, and where there’s room to grow,” said Henrike Karim-Kos, PhD, senior author and research group leader at the Princess Máxima Center and the Netherlands Comprehensive Cancer Organisation. “For policymakers, healthcare professionals, and researchers, this overview provides valuable insights to improve care and data registration. Together, we can work toward better outcomes for children with cancer.”