Clinical Profile, Diagnostic Modalities and Treatment Outcome of Primary Paediatric Brain Tumours In Durban,south Africa

Introduction Paediatric brain tumours are a significant cause of mortality and morbidity in Africa. Burden in Africa is unknown due to lack of cancer registries.

Methods A 15-year hospital based retrospective review included children(0 - 14 years) admitted with brain tumors at a quaternary hospital in Durban, South Africa between 1st January 2003 and 31st December 2017.

Results 337 patients were included, 54.6% were males. Mean age at presentation was 6.815 years [95% CI; 6.399, 7.203]. Infratentorial tumours accounted for 54.9%, supratentorial 43.9% and 1.2% involved both. 63.8% were histologically confirmed, remaining were radiologically diagnosed. Commonest tumours were brainstem gliomas (23.4%), pilocytic astrocytomas (13.4%), medulloblastoma (12.2%) and craniopharyngioma (10.7%). Tumour resection was done in 58.5% of cases, chemotherapy in 33.3% and radiotherapy in 36.6%. Commonest combination therapy included radiation and surgery (43.3%) followed by combination of the three (37.8 %). CSF diversion procedures were frequent at 82.2%. Surgical complications encountered included meningitis (10.4%), VP shunt related complications (8.6%) and panhypopituitarism (3.9%). Commonest chemotherapy regimen was ifosphomide, etoposide, cisplatin. At initial discharge, 77.2% of patients were alive. After five years of follow-up, 30.6% had died, 24.5% were still alive, 44.9% lost to follow up. Causes of death included tumour progression (57.2%), sepsis (14.5%) and tumour recurrence (6.4%).

Conclusion Gliomas are the commonest paediatric brain tumour in KwaZulu-Natal. Five-year survival rate is low with poor long term follow up among survivors. Need for a collaborative framework among hospitals to ensure early referral and long term follow up of these patients.