Inventorying the management and outcomes of low-grade gliomas in Africa and suggestions for improvement: a scoping review

Background: Over the last decade, many advancements have been made in the management of low-grade gliomas (LGG). Overall survival outcomes are correlated with factors such as postoperative residual volumes and specific tumour biomolecular profiles such as IDH mutation status. However, there is a paucity in the data regarding the treatment strategies available for LGGs across Africa. We aimed to evaluate the epidemiology, presentations, management and outcomes of LGGs in Africa. Methods: Systematic searches of MEDLINE, Embase, and African Journals Online were performed from database inception to January 27, 2021, for studies reporting management and/or treatment of LGGs in Africa. Pooled statistics were calculated using measures of central tendency and spread. Results: A total of 554 unique studies were identified, of which 25 were included. Mean age of patients was 15.7 years (95% confidence interval [CI]: 11.8-19.6) and 56.4% were male (95% CI: 55.6-62.6%). Most patients had solitary lesions (86.0%, 95% CI: 82.8-89.1%) located in the infratentorial region (71.6%, 95% CI: 66.1-77.1%). The majority of LGGs received a histopathological diagnosis (71.7%, 95% CI: 69.2-74.2%) and astrocytoma was the most common type (81.1%, 95% CI: 78.5-83.7%). 37 patients had awake surgery (3.1%, 95% CI: 2.0-4.0%) and there were no reports of use of molecular pathology testing, intraoperative neuroimaging or 5-aminolevulinic acid (5-ALA). Gross total resection (i.e. 99-100% removed) was achieved in 74.8% of patients (95% CI: 69.6-80.0%) and there was a recurrence rate of 1.7% (95% CI: 0.9-2.4%), with a mean follow-up duration of 19.4 months (95% CI: 6.9-31.9). Conclusion: GGs are underreported in Africa. Of those reported, we found a lag in the uptake of novel techniques established in high-income countries for improving patient outcomes. Future directions would involve urging local governments and stakeholders to action further training and funding in molecular pathology testing and the use of advanced surgical adjuncts

Management and outcomes of sellar, suprasellar, and parasellar masses in low-and middle- income countries: a scoping review

Background: There are several studies which describe the current management strategies and outcomes of SMs in High-Income Countries (HICs). However, there is little known the situation regarding SMs in Low and Middle-Income Countries (LMICs) apart from studies describing the experience from tertiary centres. With this study, we identified the epidemiology, diagnosis, management, and outcomes of SMs, SSMs, and PSMs in LMICs while reviewing and synthesising the relevant literature. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis extension for Scoping Review (PRISMA-ScR) guidelines were used to report the findings. MEDLINE, Embase, Global Index Medicus, and African Journals OnLine were the databases of choice. Cases were included if the pathology was related to the sellar, parasellar or suprasellar regions. The dataset was analysed using descriptive statistics via SPSS. Results: We have includedn=16589 patients from 49 LMICs. LMICs with the most studies were in China (n=49, 4.9%). Headache was the most reported symptomn=3995 with a mean of 29.82 cases per study (Range 0–130). Most reported tumour location was the sellar regionn=12933 (85%). Somatotroph adenomas was the most diagnosed pituitary adenoma (n=3297). The most frequently diagnosed non-pituitary adenomatous mass was arachnoid cysts (n=282). Endoscopic approaches were far more utilised compared to microsurgical approaches, n=3418 and n=1730, respectively. Hormonal therapies with Cabergoline were administered in 1700 patients with prolactinoma. Radiosurgery was performed in n=357 patients. The average follow-up duration was 33.26 months. Conclusion: Neuro-oncology and pituitary research in LMICs remains under-reported. Our understanding of the current landscape of the management and outcomes of sellar, suprasellar and parasellar masses show that there is similarity to the management approaches utilised compared to HICs. The surgical outcomes, although largely underreported, were worse in LMICs compared to HICs, highlighting the need for more research and education