As the global COVID-19 pandemic escalates there is a need within radiation oncology to work to support our patients in the best way possible.Measures are required to reduce infection spread between patients and within the workforce. Departments need contingency planning to create capacity and continue essential treatments despite a reduced workforce.

Purpose Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. Methods and Materials Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. Results From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19–adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules ( P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. Conclusions A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.

The development of breast implant-associated anaplastic large-cell lymphoma (ALCL) is a rare phenomenon. A typical presentation is an effusion associated with a breast implant. Less commonly, disease can be more advanced locoregionally or distantly. The optimal treatment schema is a topic of debate: localized ALCL can potentially be cured with implant removal alone, while other cases in the literature, including those that are more advanced, have been treated with varying combinations of surgery, chemotherapy, and external beam radiotherapy. This is a case report of breast implant ALCL with pathologically proven lymph node involvement, the fifth such patient reported. Our patient experienced a favorable outcome with radiation therapy and chemotherapy.

Purpose:To compare dose distributions calculated using the iPlan XVMC algorithm and heterogeneities corrected/uncorrected Pencil Beam (PB‐hete/PB‐homo) algorithms for SBRT treatments of lung tumors.Methods:Ten patients with centrally located solitary lung tumors were treated using MC‐based SBRT to 60Gy in 5 fractions for PTVV100%=95%. ITV was delineated on MIP‐images based on 4D‐CT scans. PTVs(ITV+5mm margins) ranged from 10.1–106.5cc(mean=48.6cc). MC‐SBRT plans were generated with a combination of non‐coplanar conformal arcs/beams using iPlan‐XVMC‐algorithm (BrainLABiPlan ver.4.1.2) for Novalis‐TX consisting of HD‐MLCs and 6MV‐SRS(1000MU/min) mode, following RTOG 0813 dosimetric criteria. For comparison, PB‐hete/PB‐homo algorithms were used to re‐calculate dose distributions using same beam configurations, MLCs/monitor units. Plans were evaluated with isocenter/maximal/mean doses to PTV. Normal lung doses were evaluated with V5/V10/V20 and mean‐lung‐dose(MLD), excluding PTV. Other OAR doses such as maximal spinal cord/2cc‐esophagus/max bronchial tree (BT/maximal heart doses were tabulated.Results:Maximal/mean/isocenter doses to PTV calculated by PB‐hete were uniformly larger than MC plans by a factors of 1.09/1.13/1.07, on average, whereas they were consistently lower by PB‐homo by a factors of 0.9/0.84/0.9, respectively. The volume covered by 5Gy/10Gy/20Gy isodose‐lines of the lung were comparable (average within±3%) when calculated by PB‐hete compared to XVMC, but, consistently lower by PB‐homo by a factors of 0.90/0.88/0.85, respectively. MLD was higher with PB‐hete by 1.05, but, lower by PB‐homo by 0.9, on average, compared to XVMC. XVMC max‐cord/max‐BT/max‐heart and 2cc of esophagus doses were comparable to PB‐hete; however, PB‐homo underestimates by a factors of 0.82/0.89/0.88/0.86, on average, respectively.Conclusion:PB‐hete significantly overestimates dose to PTV relative to XVMC ‐hence underdosing the target. MC is more complex and accurate with tissue‐heterogeneities. The magnitude of variation significantly varies with ‘small‐island‐tumor’ surrounded by low‐density lung tissues ‐PB algorithms lacks later electron scattering. Dose calculation with XVMC for lung SBRT is routinely performed in our clinic, its performance for head' neck/sinus cases will also be investigated.

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