Outcome of Pediatric Low Grade Gliomas in Developing Countries: the Impact of Elimination of Radiotherapy


ackground: The care of pediatric low grade gliomas (LGG) of central nervoussystem in developing countries is still suboptimal. By introduction of chemotherapyand avoiding of radiotherapy in children, better outcome should be achievable.Objectives: to evaluate the impact of replacement of radiotherapy by chemotherapy on the survival rate for children with LGG.Methods: A retrospective study was conducted of records of patients (n=85; 48 males; median age 6 years) with LGG from May 2003 to December 2009 at King Hussein Cancer Center, Jordan. Patient demographics, tumor characteristics, treatment plan, and outcomes were studied.Results: Five-year event free survival (EFS) and overall survival (OS) rates were 60%±7.3% and 92%±4.1%, respectively. The most common tumor site was the Posterior fossa/cerebellum and the suprasellar/hypothalamic area (n=23 each). The most common pathologic diagnosis was pilocytic astrocytoma (n=62). Initial surgical interventions were gross total resection (n=21), subtotal resection (n=20), and partial resection/biopsy (n=39). Posterior fossa tumors were more likely to have gross total or subtotal resection (n=17) compared to tumors in other sites. The most commonly used chemotherapeutic regimen was carboplatin/vincristine (n=29) followed by Vinblastine (n=6). There was a significant difference in the 5-year EFS by the tumor location (P=0.048) and degree of surgical resection (P=0.023). There was no statistical significance in outcome by the type of chemotherapy used (P=0.57).Conclusions: LGG management in developing countries can be improved through a multidisciplinary approach. The main impact of this approach was the elimination of radiotherapy from the management of most patients with LGG.