Treatment patterns of glioma in Pakistan: An epidemiological perspective

Abstract

Objective: To define the landscape of treatment patterns and current epidemiological data regarding gliomas in Pakistan.
 Methods: As part of the Pakistan Brain Tumour Epidemiology Study (PBTES), data were collected from 32 neurosurgical centres across the country. Our retrospective study looked at patients who underwent surgical procedures for gliomas in 2019 in neurosurgical centres. The data was collated and analysed using STATA version 15.
 Results: A total of 781 patients with gliomas were identified 479(61.8%) in public sector hospitals, 302(39.1%) in the private sector). The most common histopathological subtypes were glioblastoma 262 (33.5%), followed by astrocytoma 147(18.8%) and oligodendroglioma 93(11.9%). Gender distribution was skewed towards men 508(65%). Private institution hospitals performed surgical biopsies as the first surgical procedure 75(23%) more often than public hospitals 38(9%). Chemotherapy was given to 115(29.8%) patients, and there was no data regarding 467(53%) of patients. Similarly, only 202(43.9%) patients received radiation therapy, and there was no data for 469(60%) of patients. For high-grade gliomas specifically, only 95(31.8%) patients with HGG have a record of receiving radiation therapy, and only 57(18.9%) had a record of being started on chemotherapy.
 Conclusions: Our study highlighted gaps in glioma management within Pakistan, with only around half of our
 patients receiving chemotherapy and radiotherapy, despite it being indicated. In our experience, high-grade
 tumours were diagnosed at a younger age than in high-income countries, but overall, glioblastoma was a smaller
 constituent of our tumour sample than expected.
 Keywords: Glioblastoma. Oligodendroglioma, Glioma, Astrocytoma, Brain Neoplasms, Registries, Epidemiology.
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Survival Analysis and Correlates with Molecular Epidemiology: 10-year Retrospective Series of High-Grade Glioma in Pakistan

“…[3] Treatment for brain tumors, particularly aggressive HGG, is multidisciplinary and long-term, requiring various specialists working in tandem to achieve the goals of tumor control and surveillance. [4] Surgery for cytoreduction is indicated based on tumor location, proximity to eloquent areas, and other critical structures. While the surgical extent of resection correlates with overall survival (OS), surgeons can be forced to resort to sub-total resection or biopsy procedures to prevent neurological injury.…”

“…[ 6 ] Epidemiological data from multiple hospitals in Pakistan have highlighted glioblastoma as the most common presenting glioma subtype, however, with a younger age group than what has been reported in the CBTRUS. [ 4 , 7 ] Despite this, there is a lack of data on the response to chemotherapy and radiotherapy after surgery for HGG in our region, particularly concerning OS and PFS. This study aims to present follow-up data from one of the largest cancer hospitals in our region on HGG with molecular characterization, OS, and PFS and discusses the implications for management.…”