Primary Pediatric Brain Tumors in the African Continent: A Systematic Literature Review and Proposed Solutions for Resource-Limited Environments

Introduction: Pediatric brain tumors (PBT) are an overwhelming contributor to childhood mortality worldwide. This systematic literature review aims to synthesize existing literature on tumor characterization, management, and outcomes across the entire African continent.

Methods: A systematic review of the literature was completed across the PubMed, Google Scholar, and Web of Science databases following PRISMA guidelines. Studies discussing PBTs in Africa were included.

Results: 35 retrospective studies consisting of 5686 pediatric patients (7.13±2.73 years old) were included. Nigeria was the most represented country with 7 studies (20%), followed by Egypt and South Africa with 6 studies (17.1%) each. 28 papers reflected a male preponderance of 51% (2431 patients). Medulloblastoma was the most common lesion type in 1002 patients (18%), followed by gliomas in 420 patients (7%). 12 studies specified location of tumor with 739 patients (55.9%) presenting with a supratentorial tumor while 584 patients (44.1%) presented with an infratentorial tumor. Among the 16 studies discussing tumor grading, WHO grade I was most common (420, 20.7%), followed by grade IV (330, 16.2%) while grade III was the least common (81, 5.4%). 623 patients (41.8%) underwent gross-total resection (GTR) while subtotal resection (STR) was performed on 284 patients (20.9%). 317 patients (59%) received radiotherapy. 13 patients (25%) from 3 studies, underwent chemotherapeutic treatment. From 6 studies that discussed patient follow-up, 121 patients (30.1%) were lost-to-follow-up. The mortality rate was 21.9% (341 patients) across 13 studies. Among 13 studies, 6 (46%) indicated the need for a childhood cancer registry, and 6 studies (46%) discussed limitations to adequate healthcare such as a lack of multidisciplinary care, deficient modernized therapeutic facilities, and poor follow-up.

Conclusion : Further studies are required to draw widespread statistical conclusions regarding management and outcomes of PBTs in Africa. To provide adequate care for PBTs in Africa, local and international collaborators should discuss multidisciplinary care, resource modernization, and infrastructure to increase follow-up.