Management of Glioblastoma Multiforme as a Big Challenge for Neurosurgeons and Radiation Oncologists in Covid-19 Era: An Institutional Experience in a Rural Sub-Himlayan Region
Journal of Surgery and Surgical Research
Objectives: To illustrate our institutional experience about the challenges we faced and steps taken in the management of the patients with Glioblastoma multiforme during Covid 19 crises at Dr. R.P.G.MC Tanda. Methods: In the period of complete lockdown, patients were treated surgically without much delay. Patients with incomplete resection were given radiation while the ones with complete resection were started on tablet temozolamide (TMZ) alone and were sent home after counselling. At the
... selling. At the period of partial lockdown patients below 70 years were given option of starting on hypofractionated radiation or tab temozolamide, 55% of the patients preferred radiation over temozolamide while rest continued on tablet temozolamide. Further, the patients above 70 years were continued on tablet temozolamide and were kept on telephonic check for the onset of any neurological symptoms, those developing symptoms were immediately called and started on short course radiotherapy to a dose of 40GY/15#/3 weeks or 34GY/10#/1 weeks or 25GY/5#/1 week or were treated by Stereotactic radiotherapy 8GY/5# by Volumetric Arc Radiotherapy. Results: In our institute all of our GBM patients below 70 years remained asymptomatic when started on the non standard treatment-on tab temozolamide only post surgery or on hypofractionated course of radiotherapy and only 2% patients above 70 years developed slight symptoms showed progression of disease on check MRI scan were given hypofractionated radiotherapy. Conclusion: Covid 19 pandemic has resulted in unprecedented global healthcare crises. Our institution has illustrated the challenges we faced in managing patients with highly dreadful Glioblastoma multiforme. Due to the fear of increased risk of Covid 19 infection in the cancer patients which would result in devastating complications and very poor outcome, the non standard strategy of keeping the patients on tab temozolamide only post surgery or on hypofractionated course of radiotherapy resulted in symptomatic relief in patients below 70 years of age and only 2% patients above 70 years who developed slight symptoms showed progression of disease on check MRI scan. . Though, not standard this strategy can be considered in covid-19 crises.