Low Grade Glioma - A COVID Low Surgical Priority?

Abstract

Abstract AIMS During the COVID pandemic (March 2020) SBNS published guidance advising that low grade gliomas (LGG) should be categorised as “low surgical priority”, therefore surgery could be delayed by six months. Aims: (1) Examine the effect of the COVID pandemic on the time taken from neuro-oncology MDT discussion to surgery in presumed LGG. (2) Investigate the proportion of presumed LGG receiving an integrated diagnosis of high grade glioma (HGG) before and during the COVID pandemic. METHOD Retrospective case note analysis of patients with presumed LGG including radiological and histopathological reports. Population split into two groups – Group A pre-pandemic (March 2019-2020) and Group B mid-pandemic (March-December 2020). RESULTS Forty-three patients (30M, 13F) with presumed LGG were identified – 23/43 in Group A and 20/43 in Group B. Mean age was 45 years (26-77y). Twenty-two patients (Group A 12/23 (52%) & Group B 10/20 (50%)) had no radiological features of transformation. Mean number of days between discussion and surgery was 32 (2-96 days, SD=28) for group A and 98 (6-286 days, SD=92) for group B (p=.006: [95% CI: 21-110]). Fifteen patients in each group (65% v 75%) had an integrated diagnosis of HGG (p=.486). Of the patients with no radiological features of transformation 6 (50%) had a HGG in Group A and 7 (70%) in Group B (p=.342). CONCLUSION During the COVID pandemic patients with presumed LGG had their surgical management significantly delayed, with an increase in the proportion who were diagnosed with HGG. Presumed LGG patients should have higher surgical priority even when resources are constrained.