There is less reported data reported from low- and middle-income countries (LMICs), where resources are constrained and reliable paediatric cancer registries are confined to single institutions or do not exist at all (14). Recent data from the South African Children’s Tumour Registry reported an age standardised ratio (ASR) of 1.7/1,000,000  for MEGCTs (15). Where data from LMICs is available, studies have shown comparable outcomes to high income countries (HICs). In South Africa these reports are limited to single institutions and have been shown to be setting appropriate, cost effective and efficacious (16). No published series exists that has investigated potential prognostic factors and treatment outcomes for MEGCTs in African paediatric populations, in particular the relationship between poverty and cancer outcomes. Rather, risk factors have been extrapolated from pooled data from much larger international collaborative groups in HICs (17, 18). As a preamble to the development of a national treatment protocol, the South African Children’s Cancer Study Group (SACCSG) undertook a national retrospective review of all children 16 years and under with biopsy-proven MEGCTs.