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| EDITORIAL |
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| Year : 2021 | Volume
: 4
| Issue : 1 | Page : 1 |
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Neuro-oncology during the COVID-19 pandemic
Michael Weller1, Emilie Le Rhun2, Patrick Roth1, Matthias Preusser3
1 Department of Neurology, University Hospital Zurich, Zurich, Switzerland
2 Department of Neurology; Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
3 Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| Date of Submission | 10-Mar-2021 |
| Date of Decision | 10-Mar-2021 |
| Date of Acceptance | 10-Mar-2021 |
| Date of Web Publication | 30-Mar-2021 |
Correspondence Address:
Dr. Michael Weller
Department of Neurology, University Hospital Zurich, Zurich
Switzerland
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/glioma.glioma_3_21
How to cite this article:
Weller M, Rhun EL, Roth P, Preusser M. Neuro-oncology during the COVID-19 pandemic. Glioma 2021;4:1 |
The coronavirus disease 2019 (COVID-19) pandemic has generated extensive concerns regarding the feasibility and safety of current patterns of diagnosis, treatment, and care for cancer patients. More than 1 year after the pandemic started to severely impact health-care worldwide, we have learned that cancer patients, including brain cancer patients, may be less at danger of COVID-19 infection and specifically serious complications from COVID-19 infection including death than initially assumed. Yet, the COVID-19 pandemic has had a major impact on how we practice neuro-oncology at least in Europe. Some of these changes may be durable, that is, they may shape our practice beyond the potential termination of the pandemic.
Not surprisingly, from the start, we have all instructed our patients and their caregivers to follow local regulations instituted to prevent further spread of the coronavirus. Yet, we have also started to rethink how often repeat neuroimaging and physical outpatient visits are necessary when patients experience prolonged phases of stable disease, remain asymptomatic, and suffer from less malignant tumors. Many colleagues may have also become more prudent when considering treatments for their patients where the perceived patient benefit remains low and immunosuppression is a likely consequence, for instance, reirradiation combined with steroids or potentially toxic systemic chemotherapy, for which there is no evidence including many salvage regimens used in recurrent glioblastoma like platinum compounds or irinotecan. It is also wise to weigh carefully benefit versus risk of alkylating agent chemotherapy, and to consider careful dosing, in patients with gliomas lacking O6-methylguanine DNA methyltransferase promoter methylation or who are frail and therefore unlikely to derive major benefit. Altogether there has been constantly increasing awareness of the adverse events of steroids in the neuro-oncology community. There are settings where hypofractionated radiotherapy may not compromise outcome but reduces treatment duration and associated travel, for example, in patients with brain metastases or in patients with glioblastoma. Clinical trial activities have been dramatically affected in Europe, mostly because of institutional regulations trying to recover resources for other activities and for concerns of unfavorable risk benefit ratios. Yet, we strongly feel that also for brain tumor patients enrolled into clinical trials, a careful risk benefit assessment is needed before treatment is discontinued. Clinical trial conduct should be facilitated, for example, by allowing virtual study visits and remote laboratory testing.
In our daily practice, we must not forget the tremendous psychological impact of transforming brain tumor patient care to virtual settings and to constantly advise social distancing to patients who may suffer from cognitive impairment and whose life expectancy may not even span beyond the end, if there is any, of the COVID-19 pandemic. In the absence of data on the efficacy and safety of severe acute respiratory syndrome coronavirus 2 vaccines in the specific population of brain tumor patients, general recommendations for vaccination of cancer patients should be followed. In many countries, cancer patients and their close social contacts are prioritized in vaccination programs. We advocate for dedicated research programs investigating the duration of immunity in the specific population of brain tumor patients, particularly those receiving immunomodulatory therapies such as corticosteroids, B-cell depleting antibodies, or chemotherapies.
In conclusion, old age, cardiovascular and pulmonary comorbidities, and overall frailty remain the major risk factors for a severe, protracted course and a lethal outcome of a COVID-19 infection. The lessons we have learned during the pandemic may have improved the way we practice Neuro-Oncology in some ways, and these advances should be integrated into our practice patterns beyond the end of the pandemic.
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