Pediatric low-grade glioma in Africa: A baseline study before the implementation of Global Initiative for Childhood Cancer strategies

Jaques van Heerden ^1,2* Tonya Esterhuizen ² Elhem Jbebli ³ Faten Fedhila Ben Ayed ³ Samar Rhayem ³ Imene Chabchoub ⁴ Boubacar Togo ⁵ Anel Van Zyl ² Beverley Neethling ⁶ Karla Thomas ⁷ Robyn Charlton ⁸ Thandeka Ngcana ⁹ Gita Naidu ¹⁰ Jan Du Plessis ¹¹ Richard Nyeko ¹² Joyce Balagadde-Kambugu ¹³ Laila Hessissen ¹⁴ Abdel Zeyad ¹⁵ Aya Gamal ¹⁵ Amany Mohamed Ali ¹⁶ Rana Hamdy ¹⁷ Hosam Y Asfour ¹⁷ Moatasem El-Ayadi ¹⁷ Jennifer Geel ¹⁸ Jeanette Parkes ¹⁹ Alan Davidson ²⁰

• ¹ Department of Paediatric Oncology, Antwerp University Hospital, Antwerp, Belgium
• ² Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
• ³ Hospital Children Béchir Hamza, Tunis, Tunisia
• ⁴ Centre Hôpital Universitaire Farhat Hached, Sousse, Tunisia
• ⁵ Gabriel Toure University Hospital, Bamako, Mali
• ⁶ Inkosi Albert Luthuli Central Hospital (IALCH), Durban, KwaZulu-Natal, South Africa
• ⁷ Frere Hospital, South Africa, East London, South Africa
• ⁸ University of the Witwatersrand, Johannesburg, South Africa
• ⁹ Chris Hani Baragwanath Hospital, Johannesburg, Gauteng, South Africa
• ¹⁰ Department of Paediatrics, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
• ¹¹ University of the Free State, Bloemfontein, Free State, South Africa
• ¹² Lira University, Lira, Uganda
• ¹³ Uganda Cancer Institute (UCI), Kampala, Central Region, Uganda
• ¹⁴ Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Rabat-Sale-Kenitra, Morocco
• ¹⁵ Alexandria University, Alexandria, Egypt, Alexandria, Egypt
• ¹⁶ South Egypt Cancer Institute, Assiut University, Asyut, Asyut, Egypt
• ¹⁷ National Cancer Institute, Cairo University, Cairo, Beni Suef, Egypt
• ¹⁸ Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
• ¹⁹ Groote Schuur Hospital and University of Cape Town, South Africa, Cape Town, South Africa
• ²⁰ Red Cross War Memorial Children's Hospital, Cape Town, South Africa

Introduction Pediatric low-grade glioma (LGG) is a World Health Organization Global Initiative (GICC) for Childhood Cancer index tumor constituting a third of pediatric central nervous system tumors. The baseline characteristics, survival, and management resources for pediatric LGG in Africa are unknown. We aimed to evaluate the pediatric neuro-oncology multidisciplinary team resources, epidemiology, and survival outcomes of pediatric LGG in Africa to document baseline information prior to GICC implementation. Methods The study consisted of a survey completed by African pediatric oncology units (POU) to evaluate the local resources and a retrospective evaluation of data to determine the five-year overall survival (OS) for patients under 18 years diagnosed between 2008 and 2018. Data were described in frequencies and percentages. Survival was expressed with Kaplan-Meier curves. Results Five-hundred and eighty-eight patients were included from fifteen POUs in six countries: South Africa (45.9%), Egypt (30.8%), Morocco (12.6%), Mali (4.4%), Tunisia (3.6%) and Uganda (2.7%). The median age was 4.4 years (IQR 2.4 to 7.3 years). The most common primary tumor site was the brainstem (n=125, 21.3%), most common histology was pilocytic astrocytoma (n=270, 47.5%), 93% (n=292) of tumors were localized, and 40 (6.8%) patients had neurofibromatosis. Complete resection was obtained in 99 (16.8%) cases, incomplete resection in 179 (30.4%), and no surgery or biopsy only was performed in 310 (52.7%) cases. One-hundred and forty-seven (25.3%) of 580 patients were irradiated. Only 259 (15.3%) patients received chemotherapy of which the most common chemotherapy regimen was vincristine-carboplatin (n=220, 84.9%). The five-year OS was 90.5%±1.6%. Four of the 41 (9.8%) responding countries reported having pediatric neuro-oncology subspecialists, and four (9.8%) had national pediatric LGG protocols. In Africa there is one radiotherapy center per 2,235,125 children and one neurosurgeon per 304,685 children, with approximately 70% of these resources in four countries. Discussion Due to several resource challenges and developing treatment centers, only fifteen pediatric oncology units from six countries participated. We documented a baseline five-year OS of 94.9% for LGG in African children. To obtain an accurate estimation of pediatric LGG survival in Africa, increasing participation from a wider range of countries, especially poorly resourced settings, is necessary.