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Covid-19 HSE Clinical Guidance and Evidence

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Cancer Care - Radiation Oncology

NCCP advice for medical professionals on the treatment of patients with CNS tumours with radiotherapy in response to the COVID-19 pandemic (CD 19-183/16.06.20)


  • This document relates to patients who do not have COVID-19 or are not suspected of having COVID-19.
  • Current events surrounding the COVID-19 pandemic are challenging and all public health bodies are placing the safety of patients, staff and communities first in all decisions.
  • This is an evolving situation. This advice is based on current information, it is additional to the advice of the NPHET, the HSE and the DoH, and will be updated as necessary.
  • The NCCP acknowledges that each hospital is working under individual constraints, including staff and infrastructure, and as a result will implement this advice based on their own unique circumstances.
  • The purpose of this advice is to maximise the safety of patients and make the best use of HSE resources, while protecting staff from infection. It will also enable services to match the capacity for cancer care to patient needs if services become limited due to the COVID-19 pandemic.
  • Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment.
NPHET, HSE and DoH advice

Hospitals will operate under the overarching advice of the National Public Health Emergency Team (NPHET), the HSE and the DoH. Information is available at:

Purpose
  • This guidance document provides guidance on the appropriate treatment of CNS tumours with radiotherapy during the COVID-19 pandemic taking into account projected capacity impact levels.
Projected impact levels
  • For each of the clinical departments, the following are suggested impact levels as measured against normal roster staffing levels:

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  • Please refer to ‘NCCP advice on radiation therapy capacity escalation plan in response to the current COVID 19 pandemic’ for more information.
Recommendations for patients with high grade gliomas (1-7)

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Recommendations for Low Grade Gliomas

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Recommendations for meningioma

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Recommendations for Other Low Grade Tumours
  • For example Ependymoma Gr 1 or 2 in Spine or Brain

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Recommendations for benign diseases

Craniopharyngioma

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Pituitary tumours

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Arteriovenous malformations (AVM)

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Vestibular Schwannomas

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Trigeminal Neuralgia

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Symptomatic Patients
  • All symptomatic patients with CNS tumours should be considered for RT regardless of level except for level 5 where it may not be feasible and palliative care alone may have to be considered. Consider discussion with other Consultant Radiation Oncologists and/or with SRS MDT and/or Neuro Oncology MDT
Gaps in RT
  • Gaps in patients on Radiotherapy treatment should be avoided due to patients becoming COVID-19 positive or suspected of being COVID-19 positive due to symptoms of COVID-19 and where a test result is waited. These gaps should be compensated for where possible.
Complex CNS Tumour Cases
  • Complex CNS tumour cases can be discussed with fellow CNS consultant radiation oncologists and / or at SRS MDT and/or neuro oncology MDT.
References
  • 1.  Jastaniyah, N., Murtha, A., Pervez, N., Le, D., Roa, W., Patel, S., Mackenzie, M., Fulton, D., Field, C., Ghosh, S. and Fallone, G., 2013. Phase I study of hypofractionated intensity modulated radiation therapy with concurrent and adjuvant temozolomide in patients with glioblastoma multiforme. Radiation Oncology, 8(1), p.38.
  • 2.  Reddy, K., Damek, D., Gaspar, L.E., Ney, D., Waziri, A., Lillehei, K., Stuhr, K., Kavanagh, B.D. and Chen, C., 2012. Phase II trial of hypofractionated IMRT with temozolomide for patients with newly diagnosed glioblastoma multiforme. International Journal of Radiation Oncology* Biology* Physics, 84(3), pp.655-660.
  • 3.  Panet-Raymond, V., Souhami, L., Roberge, D., Kavan, P., Shakibnia, L., Muanza, T., Lambert, C., Leblanc, R., Del Maestro, R., Guiot, M.C. and Shenouda, G., 2009. Accelerated hypofractionated intensity-modulated radiotherapy with concurrent and adjuvant temozolomide for patients with glioblastoma multiforme: a safety and efficacy analysis. International Journal of Radiation Oncology* Biology* Physics, 73(2), pp.473-478.
  • 4.  Hingorani, M., Colley, W.P., Dixit, S. and Beavis, A.M., 2012. Hypofractionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future? The British Journal of Radiology, 85(1017), pp.e770-e781.
  • 5.  Stupp, R., Hegi, M.E., Mason, W.P., Van Den Bent, M.J., Taphoorn, M.J., Janzer, R.C., Ludwin, S.K., Allgeier, A., Fisher, B., Belanger, K. and Hau, P., 2009. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. The Lancet Oncology, 10(5), pp.459-466.
  • 6.  Perry, J.R., Laperriere, N., O’Callaghan, C.J., Brandes, A.A., Menten, J., Phillips, C., Fay, M., Nishikawa, R., Cairncross, J.G., Roa, W. and Osoba, D., 2017. Short-course radiation plus temozolomide in elderly patients with glioblastoma. New England Journal of Medicine, 376(11), pp.1027-1037.
  • 7.  Malmström, A., Grønberg, B.H., Marosi, C., Stupp, R., Frappaz, D., Schultz, H., Abacioglu, U., Tavelin, B., Lhermitte, B., Hegi, M.E. and Rosell, J., 2012. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. The Lancet Oncology, 13(9), pp.916-926.
  • 8.  Karim, A.B., Maat, B., Hatlevoll, R., Menten, J., Rutten, E.H., Thomas, D.G., Mascarenhas, F., Horiot, J.C., Parvinen, L.M., van Reijn, M. and Jager, J.J., 1996. A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. International Journal of Radiation Oncology* Biology* Physics, 36(3), pp.549-556.
  • 9.  Shaw, E., Arusell, R., Scheithauer, B., O’fallon, J., O’neill, B., Dinapoli, R., Nelson, D., Earle, J., Jones, C., Cascino, T. and Nichols, D., 2002. Prospective randomized trial of low-versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. Journal of Clinical Oncology, 20(9), pp.2267-2276.
  • 10.  Van den Bent, M.J., Afra, D., De Witte, O., Hassel, M.B., Schraub, S., Hoang-Xuan, K., Malmström, P.O., Collette, L., Piérart, M., Mirimanoff, R. and Karim, A.B.M.F., 2005. Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. The Lancet, 366(9490), pp.985-990.

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