Radiotherapeutic management of brain tumours during the COVID-19 pandemic

Rajan, Balakrishnan; Sebastian, Patricia; Rajkrishna, B; Venkatasai, Jeyaanth; Backianathan, Selvamani

doi:10.1017/s1460396920000394

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…in poor PS) Anaplastic oligodendroglioma (up to 4-6 month) Continue any progressing RT: High priority: Large benign tumors with acute symptoms (pressure, loss of sight); posterior fossa tumors (malignant or non-malignant) causing life-threatening hydrocephalus. High-intermediate priority: Medulloblastoma; Young Grade 3 glioma Intermediate priority: High-grade glioma in young fit patients Low priority: Small benign tumors; HGG in elderly, low-grade glioma ( Neuro-oncology treatment guidance during COVID-19 pandemic, 2021 ) High-Grade Glioma: Standard of care (surgical resection followed by RT) Considerable tumor volume (gliomatosis) Involvement of brainstem/spinal cord Grade III astrocytoma Delicate or older patients: Hypo-F accelerated course (34 Gy /10 frs or 40.05 Gy / 15 frs and 25 Gy / 5 frs for smaller tumors) IDH-wild-type and IDH-mutant glioma: shorten RT courses ( Vordermark, 2020a ) Low-grade glioma asymptomatic meningioma G1-2 Glioblastoma, Frail/elderly (40 Gy / 15 frs or 25 Gy / 5 frs) ( Kochbati et al, 2020 ) GBM: - Aged ≥ 65 yrs with excellent PS: Hypo-F RT (40 Gy /15 frs) - Aged < 65 yrs with good PS (KPS ≥ 70): standard fractionation (60 Gy / 30 frs) -Poor PS (KPS < 50): palliative regimens (34 Gy /10 frs or 25 Gy /5 frs) ( Noticewala et al, 2020b ) GBM: Elderly with poor KPS/unmethylated - Grade 1, Grade 2, and Grade 3 meningiomas - Schwannomas - Low-grade gliomas - Meningioma: (Hypo-F RT) Grade 1, Grade 2: 25 Gy / 5 frs Grade 3: 45 Gy in 15 fractions -Schwannomas: frameless SRS/ Hypo-F RT (25 Gy / 5 frs) -GBM: Elderly with poor KPS/methylated: 34 Gy /10 frs or 5 Gy weekly × 6 weeks Younger patients good KPS: Hypo-F RT (60 Gy / 20 frs (SIB technique) -Medulloblastoma: Start with posterior fossa boost and then switch over to craniospinal RT with VMAT/IMRT -Cystic craniopharyngiomas: For all post-op patients, start on RT ( Balakrishnan et al, 2020 ) Asymptomatic meningioma grade I-II Asymptomatic AVM Grade 3 glioma (anaplastic oligodendroglioma) for 4-6 months Non-co-deleted (anaplastic astrocytoma) Hypo-F RT: 40 Gy/15 frs or 30 Gy/6 frs ( Hinduja et al, 2020 ) …”

Section: Resultsmentioning

confidence: 99%

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Siavashpour

Goharpey²,

Mobasheri

2021

Critical Reviews in Oncology/Hematology

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Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.

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Section: Resultsmentioning

confidence: 99%

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Siavashpour

Goharpey²,

Mobasheri

2021

Critical Reviews in Oncology/Hematology

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“…Several factors, namely age, performance status, histology, surgery and history of post-operative adjuvant therapy contribute to the course of disease. In neuro-oncology, radiotherapy plays an important role in the management of brain tumors [6] . It is important for neurosurgeons to understand not only on how to administer it in general, but also about what and when to give it to patients with various diseases, including COVID-19.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Pediatric Germinoma With SARS-CoV-2: Lessons Learned From an Academic Tertiary Referral Hospital in Asian COVID Epicentrum

Rahmadhan

Parenrengi

Suryaningtyas

2022

International Journal of Surgery Case Reports

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Background Patients often present with one or more pre-existing underlying chronic diseases that will affect their prognoses and mortality. A study revealed that the majority of children with SARS-CoV-2 infection presented with either no or a single symptom. Meanwhile, multiple other studies reported of more severe disease in SARS-CoV-2 infected children with brain tumor and/or cancer as a whole. Case report The patient was a 15-year-old male who was referred to our hospital with complaints of vomiting, headache, and signs of worsening right hemiparesis. Initial MRI suggested of a high-grade astrocytoma and hydrocephalus, but a subtotal tumor resection and external ventricular drainage gave light to a histopathological examination conclusive of germinoma. After adhering to radiotherapy and recovering well, the patient fell into unconsciousness 9 months later and tested positive for SARS-CoV-2 infection. The patient deteriorated on the third day of admission with respiratory failure, shock, arrythmias, fever, and increased d-dimer. After multiple attempts stabilization with ventilatory, defibrillator, and medical support, the patient deceased at the 6th day of admission. Discussion Cancer patients with COVID-19 have been reported to have relatively higher mortality rate when compared to the non-infected patients. Moreover, malignancies were also reported to increase the risk of developing more severe disease in children. Although rare, patients may develop a condition called multisystem inflammatory syndrome in children (MIS-C), which is a state of hyperinflammatory and severe illness temporally associated with COVID-19 infection. No observations have been evident in indicating the influence of COVID-19 on the neurological state of the patient, but we believe that it may be reasonable to not yet exclude the possibility of it of exacerbating the CNS malignancy our patient suffered from. Conclusion Children with intracranial brain tumor infected by SARS-CoV-2 may fall into a worse condition with poor prognosis, exacerbated by severe acute respiratory distress and the need for breathing support in intensive care unit. Multidisciplinary tumor boards have to convene regularly, including through call-conferences and telemedicine platforms.

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“…[ 9 ] Glioma patients and families admitted to the hospital should be educated to wash their hands properly, wear protective masks, and be assisted by one family member only. [ 4 ]…”

Section: Surgery Indication In Glioma Patient During Covid-19 Pandemicmentioning

confidence: 99%

“…[ 2 , 3 ] Case fatality rate for cancer patients compared to non-cancer patients in the absence of COVID-19 is 5,6:2,1. [ 4 ] The study conducted by Liang et al . in cancer patients during COVID-19 pandemic showed that 38% had a higher risk of severe events.…”

Section: Introductionmentioning

confidence: 99%

Glioma diagnosis and comprehensive management during COVID-19 pandemic: A proposed algorithm

Cecilia

Ardiansyah

2023

JNRP

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The coronavirus disease 2019 (COVID-19) has significantly changed the health-care system. COVID-19 patients with comorbidities are more likely to have severe disease, often leading to death. As one primary concern in this pandemic era, glioma patients have an incidence of 30%. It has a high mortality rate. Glioma has multiple comorbidities, at risk of contracting COVID-19, such as elderly, taking high-dose steroid therapy with adjuvant radiotherapy (RT) and chemotherapy. An algorithm for patient-doctor communication, inpatient-outpatient selection, and treatment goals in glioma patients should be carefully made according to local preparation for COVID-19. Surgery, RT, and chemotherapy should be tailored individually to increase survival rate, quality of life, and reduce the risk of COVID-19 exposure. All communication between the health-care provider and patient will be using telemedicine. The patient who requires to visit the inpatient ward will be carefully selected. Asymptomatic glioma or with no progressivity of the disease should have the treatment postponed. Symptomatic high-grade glioma patients with progressive neurological deficits and increased intracranial pressure will be treated with COVID-19 protocols. Surgery, RT, and chemotherapy, especially Temozolomide, will be given after evaluating the patient’s age, Karnofsky Performance Scale (KPS) Score, and molecular finding of O6-methylguanine DNA methyltransferase (MGMT), isocitrate dehydrogenase, and gene 1p/9q. Therefore, it is necessary to have a modified algorithm for glioma patients during this pandemic. Key Messages: A strategy to minimize hospital contact for glioma patients in a pandemic crisis while not delaying their diagnostics and treatments

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Radiotherapeutic management of brain tumours during the COVID-19 pandemic

Cited by 5 publications

References 24 publications

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

A Case Report of Pediatric Germinoma With SARS-CoV-2: Lessons Learned From an Academic Tertiary Referral Hospital in Asian COVID Epicentrum

Glioma diagnosis and comprehensive management during COVID-19 pandemic: A proposed algorithm

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