93 The impact of Covid-19 on decision making in patients with Glioblastoma, what have we learnt?

Abstract

Glioblastoma multiforme (GBM) is the most common primary brain tumour in adults, associated with poor prognosis despite multimodal therapy. This retrospective study evaluates the impact of and the COVID-19 pandemic in patients with GBM. A retrospective review of 231 patients diagnosed with GBM at Velindre Cancer Centre between 2018 and June 2023 was conducted. Data were collected on demographics, performance status (PS), treatment modalities, molecular markers, and survival. Survival analyses were performed using Kaplan–Meier curves, with statistical significance assessed by log-rank test. The median overall survival was 8.8 months. One and five year survival was 40% and 2.3% respective. Factors associated with improved survival were total surgical resection, and long course chemoradiotherapy & MGMT status. Performance status was a significant predictor of survival; patients with PS 3–4 were less likely to receive aggressive therapy and had poorer outcomes. The COVID-19 pandemic led to reduced biopsy rates: prior to the pandemic, 57% patients with WHO PS 3-4 underwent biopsy, compared to 36% during and 5% after the pandemic period. MGMT promoter methylation status was associated with improved survival: those with methylated MGMT had a median survival of 16 months, vs. 12 months in the unmethylated cohort. Performance status influences treatment decisions and survival outcomes in GBM. Despite a reduction in surgical interventions during the COVID-19 pandemic, survival outcomes were maintained, highlighting the potential for greater flexibility in diagnostic and treatment approaches in GBM management. Whilst histological diagnosis is crucial, it is evident that biopsy alone does not improve survival, therefore it should only be offered to patients with good performance status who may be fit enough to undergo oncological treatments.