Clinical profile, diagnostic modalities, and treatment outcomes of primary paediatric brain tumors at Inkosi Albert Luthuli central hospital in Durban, South Africa.

Abstract

INTRODUCTION: Primary paediatric brain tumours are associated with high mortality and morbidity in African countries with a five-year survival rate of 32% in sub-Saharan Africa vs 80% in Western countries. Data on the burden of these tumours in the African setting is sparse due to the lack of dedicated cancer registries. METHODS: Approval was obtained from UKZN ethics and research committee (BREC/00005385/2023). A total of 337 patients with primary paediatric brain tumours admitted at Inkosi Albert Luthuli Central Hospital between 2003 and 2017 were included. Data on demographics, diagnostic and treatment modalities and outcome was analysed. RESULTS: There was a male preponderance of 54.6% with a mean age of 6.8 years (range 1 month to 14 years). Most children were of the African race (89.9%). Infratentorial tumours were more common than supratentorial tumours (55.2% vs 43.6%) while 1.2% had extension into both compartments. The most prevalent tumours were brainstem gliomas [n=82; 24. 3%], pilocytic astrocytomas [n=45; 13.4%], medulloblastoma [n=41; 12.2%] and craniopharyngioma [n=36; 10.7%]. Treatment modalities were dependent on time of presentation tumour type and histology. Mean survival time was 4.54 years [95% CI: 3.764;5.312]. At 5 years, 44.5% were lost to follow-up, 31.3% died and 24.3% were alive. By bivariate analysis, factors associated with shorter survival included African race(p=0.009), infratentorial tumours(p=0.044), presence of hydrocephalus(p=0.002) and lack of any treatment modality including noradiotherapy(p<0.0001) or chemotherapy treatment (p=0.036), and surgical resection (p=0.0001). CONCLUSION: There is need for a central brain tumour registry in KwaZulu-Natal. Collaboration between hospitals and engagement of stakeholders to avail resources is required.