Treatment of patients with glioma during the COVID-19 pandemic: what we learned and what we take home for the future

Abstract

OBJECTIVECoronavirus disease 2019 (COVID-19) has changed the way in which cancer is treated. Patients with high-grade glioma (HGG) are believed to be in a vulnerable category. The aim of this study was to describe the experience of a hub cancer center and the measures that were put in place for treatment of patients with newly diagnosed and recurrent glioma.METHODSTo prevent in-hospital contagion and preserve the safety of health professionals and patients, specific protocols and strict regulations were introduced. Physical distancing, use of surgical masks, and diligent hand hygiene were adopted. Each case was discussed in a multidisciplinary board meeting before treatment. All patient candidates for surgical procedures were tested for SARS-CoV-2 with a nasopharyngeal swab and a chest CT scan. Indications for surgery were the radiological suspicion of HGG in patients with a good performance status and/or the rapid and progressive occurrence of neurological deficits. Adjuvant treatments were performed only in cases of HGG. This therapy consisted of conventional fractional radiotherapy (RT; 60 Gy/30 fractions) with concomitant and adjuvant temozolomide chemotherapy (TMZCHT) in younger patients; in elderly patients, a short course of RT was employed (40.5 Gy/15 fractions). For recurrent HGG, treatments were assessed after a careful evaluation of the patient’s general condition, neurological status, and risk of early impairment in neurological status if not treated. During simulation CT for the RT plan, each patient underwent a chest CT study. In cases in which an imaging study was suspicious for COVID-19 pneumonia, the patient was immediately isolated and rapidly underwent nasopharyngeal swab testing.RESULTSBetween March 1 and April 30, 2020, 23 HGGs were treated, and these cases are included in the present evaluation. Fifteen patients harboring newly diagnosed glioblastoma (GBM) underwent resection followed by a regimen of chemotherapy and RT, and 3 patients with newly diagnosed anaplastic oligodendroglioma underwent surgery followed by adjuvant RT. Five patients were treated for recurrent GBM, and they received surgery plus adjuvant RT. One patient in whom the simulation CT study was suspicious for COVID pneumonia was tested with a nasopharyngeal swab, which proved positive for SARS-CoV-2 infection. No patients contracted COVID-19 during hospitalization for surgery or during RT treatment. Corticosteroid therapy was administered to all patients beginning on the 1st day of RT.CONCLUSIONSThe authors’ experience during the COVID-19 pandemic showed that patients with HGG can be treated in the most effective manner without a compromise in safety. Careful selection criteria and a multidisciplinary evaluation are pivotal to assessing the optimal therapeutic strategy.

SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

“…Hospitals have developed algorithms and flow-charts to determine the need for surgical intervention or have utilized less invasive surgical techniques to minimize the length of hospital stay [ [159] , [160] , [161] ]. Additional protocols and have been effectively implemented to minimize the risk of COVID-19 transmission [ 162 , 163 ].…”

Impact of COVID-19 pandemic on the management of glioma patients around the world. An evidence-based review

“…Emergent cases were operated on with higher acuity. Developing guidelines for a better quality service for elective surgical cases amid the pandemic Pessina 2020 et al [21] Italy Italian hospitals with surgical neuro-oncology services The board of tumors planned surgical interventions with strict measurements have been undertaken, visits of relatives of the patients' were not allowed, all communications were done using telecommunication methods. Adjuvant therapies were prescribed in a more careful manner.…”

Observation of the impact of the eight-step process combined with the four-track crossover quality control applied to patients with glioma surgery: a randomised trial

“…Further, the use of the four-track cross-over quality control intervention in the nursing process involving features such as vital signs monitoring, complications prevention, and pipeline management can not only implement real-time monitoring of postoperative nursing work, but also supervise and intervene to complete various postoperative nursing tasks avoiding nursing omissions (19). In addition, the four-track cross-over quality control can detect problems in nursing work in time and implement corresponding remedial measures to help patients recover as soon as possible after surgery (20).…”