OTHER-05 THE CHALLENGES IN MANAGING CHILDREN WITH PRIMARY CENTRAL NERVOUS SYSTEM TUMORS IN UGANDA

BACKGROUND: Pediatric central nervous system tumors (CNS) are the second commonest childhood malignancy and the commonest solid tumor in children. Brain tumors are the commonest cause of death among all childhood cancers. OBJECTIVES: To describe the challenges in managing children with CNS tumors in Uganda, treated at Mulago National Referral Hospital (MNRH) from March 2019 to March 2023, using a subset of patients with the diagnoses of medulloblastoma, pineoblastoma and ependymoma. METHODS: A retrospective study was conducted in MNRH, in patients below 18 years of age, admitted with one of the three histological diagnoses. The data included time to presentation to a tertiary health center from occurrence of initial symptoms, time to surgery from time to presentation to a tertiary health center, time to a histological diagnosis from time to presentation to a tertiary health center and time to starting radiotherapy from time to presentation to a tertiary health center. RESULTS: The total number of patients was 32(44% had medulloblastoma, 37% had pineoblastoma). Of 30 patients with a recorded date of occurrence of initial symptoms, the median time to presentation to a tertiary health center was 2.5 months (95% median Cl- 1.702,3,711), with the maximum at 30 months. The median time to surgery for 24 patients was 0.92 months995%Cl- 0.460, 2.143), with a maximum of 13.8 months. The median time to a histological diagnosis for 30 patients was 1.39 months (95%median Cl- 0.680, 2.163). The median time to starting radiotherapy for 16 patients was 6.5 months (95%median Cl- 3.168, 8.724) and a maximum of 23 months. The overall one-year survival for children with ependymoma was at 62.5% (95%CI- 14.2,89.3), followed by medulloblastoma at 39.5%(95%CI-12.9,65.6) and pineoblastoma at 37.45%(95%CI-9.5,67.0). CONCLUSION: The management of pediatric CNS tumors in Uganda is still sub-optimal due to referral, diagnostic and treatment challenges.