DISP-19. Glioblastoma Treatment in Latin America: A Scoping Review

Abstract Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults. In Latin America, disparities in access to treatment raise concerns about regional therapeutic practices. This scoping review (ScR) aimed to map available evidence on therapeutic strategies for newly diagnosed GBM patients in Latin America. Systematic searches were conducted independently and in duplicate in PubMed, Cochrane, SciELO, LILACS, and Redalyc (2015–2025). Study selection, data extraction, and appraisal were performed in pairs with third-party arbitration. Eligible studies were quantitative: observational, quasi-/pre-experimental, systematic reviews (SR), and ScRs. Exclusion criteria included preclinical studies, grey literature, case series with <10 participants, and recurrent GBM. From 242 references, 22 studies were included: 13 observational, 4 case series, 2 descriptive, 2 SR, and 1 ScR. Most studies came from Cuba, Brazil, Chile, Colombia and Mexico. ROBINS-I was applied to 19 non-randomized studies: 42% had moderate risk of bias, 26% serious, and 32% critical. AMSTAR-2 showed one SR with critically low confidence (29%), another with low (82%). Therapeutic approaches varied widely, with frequent use of surgery (including sodium fluorescein and awake craniotomy), 3D/IMRT radiotherapy (RT), and temozolomide in concurrent/adjuvant settings. Early chemoradiation (<5 weeks) improved PFS, while delays >8 weeks increased progression risk (HR: 2.18, 95% CI: 3.76–4.26, p=0.006). Some studies reported carmustine, bevacizumab, or nimotuzumab. Overall survival (OS) ranged from 6 to 31 months. In a Chilean cohort, the Stupp protocol showed improved OS vs. RT alone: 14.6 vs. 9.7 months; HR 0.4, p<0.001 (univariate); HR 0.6, 95% CI:0.33–1.09, p=0.09 (multivariate). Intraoperative fluorescein and total resection were also associated with longer OS (15 vs 8 months, p=0.002; 30.7 vs 13.6 months, p=0.02). This review reveals heterogeneity in treatment, limited standardization, and a need for regionally adapted guidelines and access to innovative therapeutic options, resource-appropiate protocols and equitable care.