Management and outcomes of low-grade gliomas in Africa: A scoping review

Introduction: Despite recent advancements in the management of low-grade gliomas (LGGs), there is a paucity in the data within the African landscape. We aim to evaluate the epidemiology, management, and outcomes of LGGs in Africa. Methods: Systematic searches of MEDLINE, Embase and African Journals Online were performed from database inception to January 27, 2021, for studies reporting on LGGs in Africa. Pooled statistics were calculated using measures of central tendency and spread. Results: 554 unique studies were identified, of which 25 were included. The mean age of patients was 15.7 years (95% confidence interval (CI): 11.8-19.6) and 56.4% were male (95% CI: 55.6-62.6%). Most patients had solitary lesions (86.0%, 95% CI: 82.8-89.1%) located in the infratentorial region (71.6%, 95% CI: 66.1-77.1%). Most LGGs received histopathological diagnosis (71.7%, 95% CI: 69.2-74.2%) and astrocytoma was the most common type (81.1%, 95% CI: 78.5-83.7%). 37 patients had awake surgery (3.1%, 95% CI: 2.0-4.0%) and there were no reports of molecular pathology testing, intraoperative neuroimaging, or 5-aminolevulinic acid. Gross total resection was achieved in 74.8% (95% CI: 69.6-80.0%) and there was a recurrence rate of 1.7% (95% CI: 0.9-2.4%), with a mean follow-up of 19.4 months (95% CI: 6.9-31.9). Conclusion: LGGs are underreported in Africa. We found a lag in the uptake of techniques established in highincome countries for improving patient outcomes. Future efforts will require further training and funding in molecular pathology testing and advanced surgical adjuncts.