Pediatric low-grade gliomas; a 12-year retrospective review from a tertiary care hospital in LMIC

Background and objective: Central Nervous System (CNS) tumors are the leading solid malignancies in children, 50% of CNS tumors in children are glial tumors, with two-thirds of these gliomas being categorized as low-grade gliomas (LGG). We aimed to review the clinical profile, management, and outcomes of pediatric LGG cases. Methodology: A retrospective cohort study was conducted at Aga Khan University Hospital between 2013 and 2025 including patients aged ≤ 18 years diagnosed with LGG. Results: A total of 191 patients were identified, with a slight preponderance of male patients (51.3%). Median age was 10 years (IQR 6–14) with the larger age group being 10–18 years (50.3%). Median duration of presenting symptoms was 4 months (IQR 1–18). Headaches (n = 112, 58.6%) and vomiting (n = 93, 48.7%) were the primary presenting complaints. Tumors were predominantly supratentorial (n = 115, 60.2%). The most common histopathology was Pilocytic Astrocytoma (n = 119). Upfront surgery was done in 163 (85.3%) patients; Gross Total Resection (GTR) was achieved in 85 patients (52.1%). Twenty-six (13.7%) patients received Chemotherapy while 9 (4.8%) had radiation therapy. Disease didn’t progress in 131 (68.6%) patients while progression and relapse occurred in 36 (18.8%) and 7 (3.7%) patients, respectively. Seventeen (8.9%) patients did not have any follow-op scans. The Overall Survival (OS) was 95.3%, with only 9 deaths recorded. Biopsy was deferred to 28 patients (14.7%), a group primarily comprising Subependymal Giant Cell Astrocytomas (SEGA) (n = 17, 60.7%), Tectal Plate Glioma (n = 3, 10.7%), and Optic Path Glioma (n = 5, 17.8%). Kaplan-Meier analysis estimated a median EFS of 84.2 months (95% CI: 70.9–97.5 months). However, this estimate should be interpreted cautiously given the relatively short median follow-up and substantial right-censoring. Conclusion: Despite heterogeneity in histopathology and location, outcomes were comparable to those reported in the literature, underscoring the effectiveness of current practices while highlighting the need for improved follow-up and comprehensive outcome reporting in resource-limited settings.