Abstract Background Pediatric CNS tumors represent a priority, particularly with the WHO designation of low-grade gliomas (LGG) as one of six index childhood cancers.1,2 There is currently limited data on outcomes of pediatric patients with LGG in low- and middle-income countries (LMICs), specifically in Honduras, where no data on has ever been published . Methods We performed a retrospective analysis to report the outcomes of all pediatric LGG cases diagnosed from 2019 to 2024 at Hospital Escuela institution in Honduras. Survival (OS) was estimated using the Kaplan–Meier method, with comparisons across WHO grades assessed by log-rank testing. Results Among 143 patients diagnosed with CNS tumors, LGG (WHO grades 1–2) accounted for 67.5% (n = 96) of cases. Of the LGGs, 51% were male, with a mean age of 8.6 years ( range 0-17 years), infratentorial localization was predominant 71.4% were pilocytic astrocytoma. Subtotal resection was the predominant approach (83.2%). LGG patients were treated with AHOPCA 2009 pLGG protocol (modified carboplatin/VCR every 21 days induction and every 28 days maintenance, cumulative dose carboplatin 6.5gr/mt2 and VCR19.5m2 for a total of 47 weeks treatment). The most commonly observed toxicities were thrombocytopenia and anemia (mostly grade 3, no grade 4). Hypersensitivity reactions (all grade 2) occurred in 10.4% (n = 5). Focal radiotherapy was administered in 10.5%, and one patient received CSI. Treatment abandonment occurred in 6.4%. Five-year OS was 91.2% and 73.3% for WHO grade 1 and 2 LGGs. Conclusions LGG constituted the majority of pediatric CNS tumors in our cohort and were predominantly infratentorial, with pilocytic astrocytoma as the most frequent histology. Treatment according to the AHOPCA 2009 pLGG protocol resulted in favorable survival outcomes, with acceptable toxicity and low rates of severe adverse events. Overall, these findings support the effectiveness and tolerability of the AHOPCA-based approach in resource-limited settings, while highlighting the need for risk-adapted strategies and improved adherence to reduce treatment abandonment and further improve outcomes. 1. WHO Global Initiative for Childhood Cancer: An Overview. https://www.who.int/publications/m/item/global-initiative-for-childhood-cancer. 2. Ward, R., Jones, H. M., Witt, D., Boop, F., Bouffet, E., Rodriguez-Galindo, C., Qaddoumi, I., & Moreira, D. C. (2022). Outcomes of Children With Low-Grade Gliomas in Low- and Middle-Income Countries: A Systematic Review. JCO global oncology, 8, e2200199. https://doi.org/10.1200/GO.22.00199
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