Outcome of High Grade Gliomas in Limited Resource Country (10 Years’ Experience in Alexandria University Oncology Center 2003-2012)

Mostafa K Barakat, Abdelaziz M Belal, Shadi H Fadel and Gamal H

Background: Gliomas are the most common form of malignant primary brain tumors in adults with an annual incidence of approximately five per 100,000 people. In Egypt, primary Central Nervous System (CNS) neoplasms are rare, constituting about 1-2% of all human neoplasms, with High Grade Gliomas (HGGs) being the most common type. The study aims to discover the histo-pathological aspect of HGGs, risk factors, and descriptive analysis of treatment received in Clinical oncology department affiliated with Alexandria University Hospital. Methods: Data were collected and analyzed for four hundred and thirty four patients with histologically proven HGGs in the period between 2003 and 2012. Results: Age of patients ranged from 21 to 83 years. Most cases (80.4%) were Glioblastoma Multiform (GBM), followed by Anaplastic Astrocytoma (AA) reaching14.3% of patients. In this study, 45.4% of patients had karnofsky performance score (KPS) more than 60%. Only 2.5% of patients underwent gross total resection (GTR), 25.6% underwent Subtotal Resection (STR) and 50% of patients underwent excisional biopsy. Patients received radiotherapy were 355 about 81.8% of patients with HGGs (80.2% of them received Radiotherapy (RT) only, 11.8% received RT followed by Adjuvant Chemotherapy (ACT), 4% received Concomitant Chemoradiotherapy (CCRT) and 4% received CCRT followed by ACT), 16.6% of patients received only best supportive care (BSC) and 2.3% did not receive treatment. The median Overall Survival (OS) was 10, 13, 19 and 15 months for patients received RT only, CCRT, CCRT followed by ACT and RT followed by ACT, respectively. Conclusion: Delayed presentation and inadequate GTR together with unavailability of TMZ could affect outcome in limited resource countries.