The “new normal” for glioblastoma adjuvant treatment in a COVID-19 pandemic scenario

Abstract

Multidisciplinary treatment of brain tumors has been severely affected by the COVID-19 pandemic In the context of a decrease in the number of neurosurgical interventions by over 50% in most centers from the countries affected by the pandemic, the setting of treatment priorities becomes essential Due to the poor prognosis and biological particularities related to rapid progression, grade IV malignant gliomas are a priority in treatment The severe limitations of hospitalization possibilities in intensive care units and the reduction of the possibilities of administration of adjuvant treatment leads to the necessity to take into account the possibilities for timely administration of adjuvant treatment in the decision for the neurosurgical treatment in new glioblastoma multiforme cases Multidisciplinary team evaluation of each case is mandatory in order to make a rational decision Isocitrate dehydrogenase (IDH) mutation and methylation status of O6-methylguanine-DNA methyl-transferase (MGMT) should be assessed as far as possible IDH wild-type status should be a decisive factor in prioritizing the treatment For young patients with a favorable performance status, the standard treatment includes long-course radiotherapy with concurrent temozolomide treatment, followed by 6-cycle adjuvant treatment with temozolomide, even in a COVID-19 pandemic scenario The optimal therapeutic choice in the case of elderly and/or frail patients includes a moderate hypofractionated radiotherapy regimen of 40 Gy in 15 daily fractions over 3 weeks, or a hypofractionated protocol with 25 Gy in 5 daily fractions, taking into account the age and Karnoffsky performance status Also, the MGMT methylation status must be taken into account for the decision to omit chemotherapy and for the delivery of a short-course radiotherapy regimen (25 Gy in 5 fractions) Omission of chemotherapy should consider both the additional risk of SARS-CoV-2 infection and the limited benefit of temozolomide treatment in the case of unmethylated MGMT status © 2021, Czech Medical Association J E Purkyne All rights reserved