Figure 1.

Algorithm of Radiation Guidelines for GBM during the COVID-19 Global Pandemic at MD Anderson Cancer Center: Radiation recommendations regarding GBM in asymptomatic, COVID-19 negative, and/or patients not requiring self-quarantine at a major tertiary cancer center. ∗: Healthcare guidelines during COVID-19 pandemic are dynamic and application of the guidelines outlined should be in accordance with local institutional, state, and federal guidelines. Consider travel restrictions for new patients and use of a telemedicine platform to monitor patients for side-effects while on treatment. #: recommend multidisciplinary discussion with radiation oncology, neuro-oncology regarding systemic therapy, and neurosurgery. ≠: In patients who have tested COVID-19 negative, we recommend re-testing if the index of suspicion for COVID-19 infection is high. If a patient becomes COVID-19 positive during RT, we recommend holding RT until the patient self-quarantines for 14 days after positive test date. The patient is then screened for symptoms after completion of self-quarantine and the patient’s case undergoes multidisciplinary review to determine if he/she can resume RT. ¥: consider 60 Gy in 30 fractions with excellent performance status and without high risk CDC identified COVID-19 comorbidities. π: consider risk/benefits of hypofractionated RT if patient has the following uncontrolled comorbidities as identified by the CDC: chronic lung disease, moderate to severe asthma, serious heart conditions, immunocompromised, severe obesity, diabetes, chronic kidney disease undergoing dialysis, liver disease. Abbreviations: CDC = Center for Disease Control and Prevention; GBM = Glioblastoma; KPS = Karnofsky Performance Status; RT = Radiation treatment; TMZ = Temozolamide.