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

Abstract

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.