LGG-42. TWENTY YEARS OF PROGRESS IN MANAGING LOW GRADE GLIOMA: THE EXPERIENCE OF THE UNIVERSITY OF CAPE TOWN’S COMBINED PAEDIATRIC NEURO-ONCOLOGY SERVICE FROM 2001 TO 2022

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Abstract BACKGROUND This study aimed to review the management of childhood low grade gliomas (WHO I and II) by the University of Cape Town’s combined neuro-oncology service at Red Cross War Memorial Children’s and Groote Schuur Hospitals. METHODS All patients diagnosed with low grade glioma between 2001 and 2022 were included in this retrospective study. Real time decision-making during the study period was achieved via a weekly neuroimaging meeting, and surveillance by a combined monthly clinic attended by paediatric endocrinology and educational psychology. Despite state of the art surgical and radiotherapy facilities, molecular diagnostics, monoclonal antibodies and small molecules were only available to selected patients. RESULTS Among 129 children, aged 0.38 to 14.58 years [median 5.36], six had Tuberous Sclerosis and 11 had Neurofibromatosis-1. The commonest sites were cerebellum (26%), hypothalamus (17%) and optic pathway (16%), and 12 patients (9%) had metastatic disease, mostly grade I supratentorial tumours. Twenty-three patients were diagnosed on imaging without histology, six of whom were biopsied subsequently, yielding a total of 96 grade I and 16 grade II tumours. Initial management was expectant in 16% (including 8 of the 11 Nf-1 tumours), surgery in the form of debulking or total resection in 53%, chemotherapy in 24% and radiotherapy in 8%. Ultimately 36% received chemotherapy and 29% radiotherapy (almost all of them focal RT), and only 16% of those treated with radiotherapy progressed. Estimated 5-year Overall Survival (OS) and Progression Free Survival (PFS) was 90.5% and 52.6% for the whole group. Patients treated with chemotherapy had an OS of 87.2% and a PFS of 39.2%. PFS and OS were inferior for metastatic disease but not for grade II tumours. CONCLUSIONS Low grade glioma can be managed effectively in a middle-income country setting. Multidisciplinary team management is crucial to achieving positive outcomes regardless of context.