SIOP PODC–adapted treatment guidelines for craniopharyngioma in low‐ and middle‐income settings

Abstract

Pediatric craniopharyngioma is a rare tumor with excellent survival but significant long-term morbidities due to the loco-regional tumor growth or secondary to its treatment. Visual impairment, panhypopituitarism, hypothalamic damage, and behavioral changes are among the main challenges. This tumor should be managed under the care of a multidisciplinary team to determine the optimum treatment within the available resources. This is particularly important for low middle-income countries where resources are variable. This report provides risk-stratified management guidelines for children diagnosed with craniopharyngioma in a resource-limited setting.

Pediatric neurosurgical-oncology scope and management paradigms in Sub-Saharan Africa: a collaboration among 7 referral hospitals on the subcontinent

“…A meta-analysis evaluating differences in postoperative LOS after brain tumor surgery in HICs and LMICs showed a postoperative LOS in LMICs (10.1 days) similar to what we report in our study (10.6 days) which is longer than the postoperative LOS in HICs (5.1 days) (30). Factors accounting for longer postoperative LOS in LMICs include poorly treated comorbidities, postoperative complications, and lack of adoption of contemporary and/or minimally invasive neurosurgical approaches and techniques due to limited infrastructure (31). While this study does not compare clinical practice in HICs and LMICs, we understand historically and anecdotally there is dramatic inequity in the delivery and reception of care for pediatric CNS tumor patients between these income categories (10,11).…”

How Can Genomic Innovations in Pediatric Brain Tumors Transform Outcomes in Low- and Middle-Income Countries?

“…There has been a steady increase in reporting of the epidemiology and outcomes of pediatric brain tumors in LMICs over the past three decades. A survey of publications in comprehensive and recent review articles [28][29][30][31] reveals a dearth of literature on pediatric brain tumors in LMICs before the turn of the century, with a significant and sustained increase after the year 2000. The publications emanate from Asia, Africa, Latin America, and the Mediterranean region, but most are retrospective audits and very few describe clinical trials in the sense of prospective evaluation of a predetermined treatment strategy.…”

Understanding treatment recommendations at diagnosis of advanced cancer in pediatric oncology: The need to explore decision‐making challenges globally

“…Treatment decision-making for children diagnosed with advanced or incurable cancer in LMICs remains largely unsupported on a practical level by existing treatment guidelines that are structured by general capacity levels, within which individual institutions may not fit neatly. [6][7][8][9][10][11][12][13][14][15][16][17] There are nuanced variables to consider in decisionmaking specific to diverse cultures and contexts, and patient and family preferences that may be at odds with local capacity. 6 These discussions have led us to believe that local, communitybased research efforts that encompass all impacted voices are needed to better support the challenges of goal setting during upfront treatment decision-making for children diagnosed with advanced cancer with poor prognosis in LMICs.…”

“…While these discussions unfolded in one cancer center in one country, participating team members recognized resonance and overlapping content from subsequent discussions with other pediatric oncologists and pediatricians caring for children diagnosed with cancer in LMICs. Treatment decision‐making for children diagnosed with advanced or incurable cancer in LMICs remains largely unsupported on a practical level by existing treatment guidelines that are structured by general capacity levels, within which individual institutions may not fit neatly 6–17 . There are nuanced variables to consider in decision‐making specific to diverse cultures and contexts, and patient and family preferences that may be at odds with local capacity 6 …”