Background: Diffuse Intrinsic Pontine Glioma (DIPG) primarily affects pediatric patients. Data on the global incidence of DIPG remain sparse, especially in South Asia and low-middle-income countries like Pakistan. Methods: After exemption from the Ethics Review Committee, a retrospective study was conducted. Records of patients with DIPG at the Aga Khan Hospital in Karachi, from January 2010 to December 2022, were reviewed. Results: A total of 35 pediatric patients were diagnosed/treated for DIPG. The median age of the patients was 9, with 19 (54.3%) males and 16 (45.7%) females. Cranial nerve palsies were the most common complaint in 19 (54.3%) patients, followed by headaches in 18 (51.4%), long tract signs in 14 (40%), ataxia/cerebellar symptoms in 14 (40%), and seizures in 5 (14.3%). MRI was the primary diagnostic tool, used alone or with CT in 32 (94.1%) patients; CT alone was used in 2 (5.7%). Biopsy was performed in 10 (28.6%) patients. Primary radiation therapy was administered to 14 (40%) patients with 5400 cGy in 30 fractions. All these patients received steroids. No patients received reirradiation. VP shunt surgery for hydrocephalus was performed in 9 (25.7%) patients. Over half (54.3%) refused treatment post-diagnosis, and 71.4% were lost to follow-up. Conclusion: Providing timely, quality multi-disciplinary care to DIPG patients within resource constraints remains challenging in Pakistan. However, recent developments show promise for improving DIPG care in the country.

Background: This study aims to improve practices in pediatric radiation oncology in LMIC by sharing an institutional experience of radiation therapy (RT) for pediatric cancer at the Aga Khan University Hospital. Methods: All patients from January 2009 to December 2020 who received radiation therapy at Aga Khan University Hospital were included. Records were retrospectively reviewed from hospital information management system (HIMS) and radiation oncology information system were searched to identify children aged up to 19 years of age who received RT based on the pediatric protocol. Data was reviewed for frequencies and percentages were calculated for demographics, clinical characteristics, and treatment-related variables. Results: A total of 496 patients were offered RT for soft tissue and extra osseous sarcomas (n=115 patients, 23.2%), lymphomas and reticuloendothelial neoplasms (n=88 patients, 17.7%) and CNS and miscellaneous intracranial and intraspinal neoplasms (n=86 patients, 17.3%) and malignant bone tumors (n=77, 15.5% patients). The most common regions for radiation were head and neck (n=144, 29%) and CNS (n= 123, 24.3%). General anesthesia was used for radiation planning and/or execution of treatment in 122 (26.8%) patients. More than half the patients (n=261, 53.16%) received RT in the postoperative setting, 89 (18.13%) had RT as consolidative treatment. 30 (6.1%) leukemia patients received prophylactic radiation therapy and 103 (20.98%) received RT as a definitive treatment modality. Conclusions: Our study reinforces the use of radiation therapy in multidisciplinary management of different pediatric tumors. A multi-level pediatric cancer registry is required to assess the utilization of radiotherapy for different pediatric tumors. This will help in planning systems to cater to the needs of pediatric oncology management and survivorship.