Hypofractionation in COVID-19 radiotherapy: A mix of evidence based medicine and of opportunities

Portaluri, Maurizio; Barba, Maria Cristina; Musio, Daniela; Tramacere, Francesco; Pati, F.; Bambace, Santa

doi:10.1016/j.radonc.2020.06.036

Cited by 21 publications

(23 citation statements)

References 18 publications

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“…More than half of COVID-19 patients from our cohort had Stage III diseases amenable of curative treatment, which effectiveness could be heavily impaired by delay. Hypofractionation should be considered when feasible on a case by case basis [39][40][41], both to reduce the number of accesses and therefore limit the risk of infection for negative subjects and to complete ongoing treatment for COVID-19 positive asymptomatic or mildly symptomatic patients (as reported for two patients in our cohorts.…”

Section: Covid-19 Impact On the Staffmentioning

confidence: 88%

Two months of Radiation Oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice.

Buglione

Spiazzi

Guerini

et al. 2020

Preprint

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Abstract Background: Coronavirus Disease 2019 (COVID-19) pandemic had an overwhelming impact on healthcare worldwide. Outstandingly, the aftermath on neoplastic patients is still largely unknown, and only isolated cases of COVID-19 during radiotherapy have been published. We will report the two-months experience of our Department, set in Lombardy “red-zone”.Methods: data of 402 cancer patients undergoing active treatment from February 24 to April 24, 2020 were retrospectively reviewed; several indicators of the Department functioning were also analyzed.Results: dedicated measures allowed an overall limited reduction of the workload. Decrease of radiotherapy treatment number reached 17%, while the number of administration of systemic treatment and follow up evaluations kept constant. Conversely, new treatment planning faced substantial decline. Considering the patients, infection rate was 3.23% (13/402) and mortality 1.24% (5/402). Median age of COVID-19 patients was 69.7 years, the large majority were male and smokers (84.6%); lung cancer was the most common tumor type (61.5%), 84.6% of subjects were stage III-IV and 92.3% had comorbidities. Remarkably, 92.3% of the cases were detected before March 24. Globally, only 2.5% of ongoing treatments were suspended due to suspect or confirmed COVID-19 and 46.2% of positive patients carried on radiotherapy without interruption. Considering only the last month, infection rate among patients undergoing treatment precipitated to 0.43% (1/232) and no new contagions were reported within our staff. Conclusions: although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during SARS-Cov-2 pandemic by endorsing consistent preventive measures.

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Section: Covid-19 Impact On the Staffmentioning

confidence: 88%

Two months of Radiation Oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice.

Buglione

Spiazzi

Guerini

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…More than half of COVID-19 patients from our cohort had Stage III diseases amenable of curative treatment, which effectiveness could be heavily impaired by delay. Hypofractionation should be considered when feasible on a case by case basis [ 34 – 36 ], both to reduce the number of accesses and therefore limit the risk of infection for negative subjects and to complete ongoing treatment for COVID-19 positive asymptomatic or mildly symptomatic patients (as reported for two patients in our cohorts.…”

Section: Discussionmentioning

confidence: 99%

Two months of radiation oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice

et al. 2020

View full text Add to dashboard Cite

Background: Coronavirus Disease 2019 (COVID-19) pandemic had an overwhelming impact on healthcare worldwide. Outstandingly, the aftermath on neoplastic patients is still largely unknown, and only isolated cases of COVID-19 during radiotherapy have been published. We will report the two-months experience of our Department, set in Lombardy "red-zone". Methods: Data of 402 cancer patients undergoing active treatment from February 24 to April 24, 2020 were retrospectively reviewed; several indicators of the Department functioning were also analyzed. Results: Dedicated measures allowed an overall limited reduction of the workload. Decrease of radiotherapy treatment number reached 17%, while the number of administration of systemic treatment and follow up evaluations kept constant. Conversely, new treatment planning faced substantial decline. Considering the patients, infection rate was 3.23% (13/402) and mortality 1.24% (5/402). Median age of COVID-19 patients was 69.7 years, the large majority were male and smokers (84.6%); lung cancer was the most common tumor type (61.5%), 84.6% of subjects were stage III-IV and 92.3% had comorbidities. Remarkably, 92.3% of the cases were detected before March 24. Globally, only 2.5% of ongoing treatments were suspended due to suspect or confirmed COVID-19 and 46.2% of positive patients carried on radiotherapy without interruption. Considering only the last month, infection rate among patients undergoing treatment precipitated to 0.43% (1/232) and no new contagions were reported within our staff. Conclusions: Although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during SARS-Cov-2 pandemic by endorsing consistent preventive measures.

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“…It is worth noting that COVID-19 practical radiotherapy treatment recommendations for cancers, such as breast, cervix, lung, head and neck, prostate and colorectal have been published by various international and national organisations and societies Guckenberger et al 2020;Thomson et al 2020). For palliative non small cell lung carcinoma, 8-10 Gy/1 fraction is strongly recommended (Portaluri et al 2020). Consensus-based recommendations from American Society for Radiation Oncology and European Society for Radiology and Oncology strongly suggests 50 Gy/16 fractions for early larynx cancer (T1N0) (Thomson et al 2020).…”

Section: Discussionmentioning

confidence: 99%

Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review

Donkor

Atuwo-Ampoh

Opie

et al. 2021

Preprint

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Aim: To identify strategies adopted by radiotherapy centres in low and middle-income countries (LMICs) to mitigate the effects of COVID-19.Background: Studies summarising COVID-19 mitigation strategies designed and implemented by radiotherapy centres in LMICs to avoid delays, deferrments and interruptions of radiotherapy services are lacking.Materials and Methods: A systematic review was conducted and reported in accordance with the preferred reporting items for systematic review and meta-analysis guideline. Ovid Embase, Ovid MEDLINE and CINAHL were searched for peer-reviewed articles that reported measures adopted by radiotherapy centres in LMICs to reduce the risk of COVID-19. Information on different strategies were extracted from the included studies and textual narrative synthesis was conducted.Results: Of the 60 articles retrieved, eleven were included. Majority of the studies were conducted in China. Ten of the included studies employed a qualitative design. Four themes were identified: preparing and equipping staff; reinforcing infection prevention and control policies; strengthening coordination and communication; and maintaining physical distancing. Studies reported that radiotherapy centres have: formed COVID-19 response multidisciplinary team; maximised the use of telehealth; adjusted the layout of waiting areas; divided staff into teams; dedicated a room for isolating suspected cases; and adopted triage systems.Conclusions: Local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed radiotherapy leaders to continue to deliver radiotherapy services to cancer patients in LMICs during the COVID-19 crisis. Robust and quality data collection must be encouraged in LMICs to provide an evidence-based knowledge for use in the event of another pandemic.

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Hypofractionation in COVID-19 radiotherapy: A mix of evidence based medicine and of opportunities

Cited by 21 publications

References 18 publications

Two months of Radiation Oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice.

Two months of Radiation Oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice.

Two months of radiation oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice

Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review

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