Introduction: Temozolomide (TMZ) and radiotherapy (RT) are currently the gold standard treatment for Glioblastoma (GBM), however, access to treatment in low and middle-income countries (LMIC) is deficient. Factors include the cost of treatment, access to radiotherapy, and concentration of third-level hospitals in the major cities. Furthermore, literature regarding Stupp protocol in Latin America (LTA) is scarce, with only some sole-centric articles published with a low number of patients. We evaluate the current state of implementation of the Stupp protocol in LTA.
Methods: We performed a systematic literature review following PRISMA guidelines. Pubmed, BVS, and Scielo databases were searched using the keyword keywords “Stupp Protocol”, “Latin America”, “Gliomas”, “Temozolomide” and “Radiotherapy”. Filters were: full-text, 2004-2024, Portuguese, Spanish, English. We evaluated age, sex, country of origin, type of tumor, Stupp implementation, median progression-free survival (PFS), and median overall survival (OS), both in months.
Results: We identified 265 articles from which 18 studies were selected. A total of 2,436 patients, 1,184 (49.6%) male and 1,087 (44.6%) female, the rest were not specified. The median age was 66.9 years. Data was mostly reported from 4 different countries: 11 (61.1%) studies from Brazil, 3 (16.6%) from Mexico, 3 (16.6%) from Peru and 1 (5.5%) study from Argentina. Stupp protocol was given to 278 (11.4%) patients with an average duration of 8.71 weeks, 684 (28%) patients received only TMZ, and 770 (31.6%) underwent only RT. With a median OS of 22.15 months and a median PFS of 6.43 months.
Conclusion : As suspected, outcome reports were mainly limited to the major cities of LAT countries. The trend indicates that the number of patients undergoing a complete course of treatment is low, in addition, there is not enough information to identify an attributable cause even more when compared to more developed countries.
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