Unveiling Disparities in WHO Grade II Glioma Care Among Physicians in Middle East and North African (MENA) Countries: A Multidisciplinary Survey

Background : Low-grade gliomas (LGGs) need multi-disciplinary treatment from different specialties, directed by new molecular classifications and prognostic markers. Yet regional practice patterns and obstacles are not reported, especially in MENA countries. Method : A cross-sectional survey of physicians from MENA countries (including: neurosurgeons, radiation oncologists, and medical oncologists) was conducted by an electronic survey. The feedback included responses regarding surgical interventions, adjuvant treatment preferences, and barriers to adoption of IDH-mutant inhibitors. Results : 137 physicians (37.23% neurosurgery, 32.85% radiation oncology, 29.93% medical oncology). Most had 6–15 years of experience (56.21%) and worked in government hospitals (51.82%). Maximal safe resection (MSR), if applicable, was preferred over biopsy (89.05%). For residual Astrocytoma, concurrent radiotherapy (RT) with temozolomide (TMZ) (42.34%) was most preferred adjuvant, while 44.53% prefer observation after gross total resection (GTR). For residual Oligodendroglioma, RT followed by PCV (45.99%) was preferred, with 59.85% offered observation post- GTR. Most (96.35%) agreed that resection extent impacts outcomes, while 72.99% objected to extending TMZ beyond six cycles. High-risk stratification varied: 46.72% used age ≥40 years, and 88.32% prioritized residual tumor volume. Although 64.96% supported IDH-mutant inhibitors, 58.39% cited limited availability, cost (40.88%), and insufficient long-term data (31.39%) as a barriers. Specialty-specific differences emerged: radiation oncologists trend more to provide adjuvant radiotherapy with persistent seizure post-operatively, and medical/radiation oncologists more often used age ≥40 for high-risk stratification. Conclusion : There is a wide variation LGG management among MENA physicians. These data highlight the importance of locally derived guidelines, and collaboration between multiple disciplines to ensure optimal patient outcomes.