Abstract
Object
This study reviews the first operative series of pediatric brain tumors from Uganda, the largest series from Sub-Saharan Africa, and explores the challenges to progress in pediatric neuro-oncology in the region.
Methods
This is a retrospective operative series of brain tumors in 172 children at Cure Children’s Hospital of Uganda over 10 years. Demographics, clinical presentation, lesion location, histopathology, operative management, and outcome were investigated. Survival was assessed using Kaplan–Meier method. Log-rank test and p value with Bonferroni correction were used to determine significance of survival differences.
Results
There were 103 males (59.9 %) and 69 females (40.1 %; mean age at diagnosis 6.5 years with 29 % < 2 years). The most common histologic types were pilocytic astrocytoma (23.2 %), ependymoma (16.3 %), craniopharyngioma (9.9 %), choroid plexus papilloma (9.3 %), and medulloblastoma (8.1 %). Supratentorial tumors (62.2 %) were more common. Symptomatic hydrocephalus predominated at presentation (66.9 %). In 71 (41.3 %), the presentation was macrocephaly or a visible mass. Estimated 5-year survival was 60 %.
Conclusions
The majority of pediatric brain tumors in the region likely go unrecognized. Most that do come to attention have a “visible diagnosis.” Unlike operative series from developed countries, information about the incidence, prevalence, and overall burden of disease for different tumor types cannot be deduced from the various operative series reported from limited resource countries because of the selection bias that is unique to this context. Delayed presentation and poor access to adjuvant therapies were important contributors to the high mortality. The epidemiology of pediatric brain tumors in sub-Saharan Africa is obscure.
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References
SEER Cancer Statistics Review 1975–2004, National Cancer Institute Surveillance Epidemiology and End Results http://seer.cancer.gov/csr/1975_2004/results_merged/sect_28_childhood_cancer.pdf. Accessed 23 Jul 2013
Peris-Bonet R, Martinez-Garcia C, Lacour B, Petrovich S, Giner-Ripoll B, Navajas A, Steliarova-Foucher E (2006) Childhood central nervous system tumours—incidence and survival in Europe (1978–1997): report from Automated Childhood Cancer Information System project. Eur J Cancer 42:2064–2080
Rickert CH, Paulus W (2001) Epidemiology of central nervous system tumors in childhood and adolescence based on the new WHO classification. Child’s Nervous System 17:503–511
Hjalmars U, Kulldorff M, Wahlqvist Y, Lannering B (1999) Increased incidence rates but no space-time clustering of childhood astrocytoma in Sweden, 1973–1992: a population-based study of pediatric brain tumors. Cancer 85:2077–2090
Kaatsch P, Rickert CH, Kuhl J, Schuz J, Michaelis J (2001) Population-based epidemiologic data on brain tumors in German children. Cancer 92:3155–3164
Williams AO (1975) Tumors of childhood in Ibadan, Nigeria. Cancer 36:370–378
El-Gaidi MA, Eissa EM (2010) Infantile intracranial neoplasms: characteristics and surgical outcomes of a contemporary series of 21 cases in an Egyptian referral center. Pediatric Neurosurgery 46:272–282
Igun GO (2001) Diagnosis and management of brain tumours at Jos University Teaching Hospital, Nigeria. East African Medical Journal 78:148–151
Bellil S, Limaiem F, Mahfoudhi H, Bellil K, Chelly I, Mekni A, Jemel H, Khaldi M, Haouet S, Zitouna M, Kchir N (2008) Descriptive epidemiology of childhood central nervous system tumours in Tunisia. Experience of a single institution over a 15-year period (1990–2004). Pediatric Neurosurgery 44:382–387
Wanyoike PK (2004) Posterior cranial fossa tumours in children at Kenyatta National Hospital, Nairobi. East African Medical Journal 81:258–260
Olasode BJ (2002) A pathological review of intracranial tumours seen at the University College Hospital, Ibadan between 1980 and 1990. The Nigerian Postgraduate Medical Journal 9:23–28
Olasode BJ, Shokunbi MT, Aghadiuno PU (2000) Intracranial neoplasms in Ibadan, Nigeria. East African Medical Journal 77:4–8
Mwang’ombe NJ, Ombachi RB (2000) Brain tumours at the Kenyatta National Hospital, Nairobi. East African Medical Journal 77:444–447
El Khamlichi A (2001) African neurosurgery: current situation, priorities, and needs. Neurosurgery 48:1344–1347
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathologica 114:97–109
Kaderali Z, Lamberti-Pasculli M, Rutka JT (2009) The changing epidemiology of paediatric brain tumours: a review from the Hospital for Sick Children. Child’s Nervous System 25:787–793
Makino K, Nakamura H, Yano S, Kuratsu J (2010) Population-based epidemiological study of primary intracranial tumors in childhood. Child’s Nervous System 26:1029–1034
Wong TT, Ho DM, Chang KP, Yen SH, Guo WY, Chang FC, Liang ML, Pan HC, Chung WY (2005) Primary pediatric brain tumors: statistics of Taipei VGH, Taiwan (1975–2004). Cancer 104:2156–2167
Cho KT, Wang KC, Kim SK, Shin SH, Chi JG, Cho BK (2002) Pediatric brain tumors: statistics of SNUH, Korea (1959–2000). Child’s Nervous System 18:30–37
Eyenga VC, Ngah JE, Atangana R, Etom E, Ngowe MN, Bassong Y, Oyono JL, Sosso M (2008) Central nervous system tumours in Cameroon: histopathology and demography. Sante 18:39–42
Uche EO, Shokunbi MT, Malomo AO, Akang EE, Lagunju I, Amanor-Boadu SD (2013) Pediatric brain tumors in Nigeria: clinical profile, management strategies, and outcome. Child’s Nervous System [epub ahead of print, PMID: 23595806]
Parkin DM FJ, Hamdi-Chérif M et al. (2003) Cancer in Africa: epidemiology and prevention. International Agency for Research on Cancer Scientific Publications No. 153, IARC Press, Lyon, 381–396
Karkouri M, Zafad S, Khattab M, Benjaafar N, El Kacemi H, Sefiani S, Kettani F, Dey S, Soliman AS (2010) Epidemiologic profile of pediatric brain tumors in Morocco. Child’s Nervous System 26:1021–1027
CIA, The World Factbook (2013) https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html. Accessed 23 July 2013
World Health Organization (2013) https://www.who.int/countries/en/. Accessed 9 Sept 2013
Warf BC, Alkire BC, Bhai S, Hughes C, Schiff SJ, Vincent JR, Meara JG (2011) Costs and benefits of neurosurgical intervention for infant hydrocephalus in sub-Saharan Africa. Journal of Neurosurgery Pediatrics 8:509–521
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Stagno, V., Mugamba, J., Ssenyonga, P. et al. Presentation, pathology, and treatment outcome of brain tumors in 172 consecutive children at CURE Children’s Hospital of Uganda. The predominance of the visible diagnosis and the uncertainties of epidemiology in sub-Saharan Africa. Childs Nerv Syst 30, 137–146 (2014). https://doi.org/10.1007/s00381-013-2297-z
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DOI: https://doi.org/10.1007/s00381-013-2297-z