529 Neuro-Oncology Practice Patterns and Management Paradigms: A Global Epidemiological Survey

Abstract

INTRODUCTION: Understanding of the epidemiology and biology of pediatric central nervous system (CNS) tumors has advanced dramatically over the last decade; however there remains a discrepancy in the understanding of epidemiologic and clinical capacity-oriented data between high income and low middle- or low-income countries. METHODS: A cross sectional epidemiological survey was conducted to determine the incidence, diagnosis, management, and follow-up paradigm for pediatric CNS tumors using REDCap. The survey was administered to neurosurgeons at partner hospitals, collecting aggregate data for patients managed over the preceding 3-months. The survey was sent to the sites 3 times at 3-months interval. Descriptive statistics analyses were performed. RESULTS: Fourteen percent of outpatient and 13% of operative volume was represented by pediatric neuro-oncology at the partner sites. Only one site had no diagnostic modality available at, others had either CT scan only or both CT scan and MRI. Of 214 patients evaluated, 128 (59.8%) underwent surgery and 16 (7.5%) were referred to other centers. Mean 29.2% patients did not undergo surgery due to inadequate resources. Mean 44.4% received adjuvant chemotherapy and 27.6% received adjuvant radiotherapy when indicated. The most common tumor location was posterior fossa (26.7%). The most common pathology diagnosis was low grade glioma (17.4%). None of the six partner sites had neuropathology expertise. CONCLUSIONS: A wide variety of pediatric brain and spine tumor pathology was managed at these six national referral sites in Sub-Saharan African countries. The histopathological profile of the tumors managed at these sites was akin to previously published studies. Further resource allocation focusing on setting up pediatric neuro-neuro-oncology practices might improve care for these patients.