Epidemiology and clinical outcomes of childhood central nervous system cancers in a large low-middle income country pediatric oncology center: a report on 5051 kids.

Background: Central nervous system (CNS) tumors are the leading cause of cancer-related deaths in children. While most cases come from low-middle income countries (LMIC) where their prognosis is worse, few epidemiological studies are conducted in these regions.

Methods: We conducted a registry-based cohort study for childhood CNS tumors at Children's Cancer Hospital, Egypt (CCHE) over 15 years. Unified treatment protocols are implemented. Survival analyses were conducted using the Kaplan-Meier function. Cases were additionally annotated using the ICCC-3 classification.

Results: In total, 5051 children ≤ 18 years old were identified, accounting for 20% of all childhood cancers treated at CCHE. The most common tumor sites were the posterior fossa (36.8%) and the brainstem (17.7%). Pathologies were predominantly astrocytic (n=1360; 26.9%) and embryonal (n=1003; 19.9%) in origin. The 5yr OS and EFS for all cases were 64.6% and 51.8%, respectively. More specifically, 1421 low-grade gliomas were identified, with 5yr OS = 91.1%. Medulloblastoma (n=801) recorded a 5yr OS of 66%. The entity with the worst prognosis was DIPG (n=633) with 5yr OS = 3.2%.

Conclusions: We report on a large number of childhood CNS tumors from a LMIC. This study underscores the need to understand the burden of childhood brain tumors and its outcomes in resource-constrained settings.

Impact: This study reports on the epidemiology and clinical outcomes of 5000+ children with CNS tumors from a specialized LMIC center. Despite the lack of many sophisticated and advanced facilities, LMIC can improve the clinical end results with experience and augmented efforts.