Optimizing lung cancer radiation treatment worldwide in COVID-19 outbreak

Abstract

COVID-19 has spread around the planet, sending billions of people into lockdown as health services struggle to cope. Meanwhile in Asia, where the disease began, the spread continues, in China it seems for now to have passed its peak. Italy, Spain, France, UK, and the US have been the countries more affected in terms of deaths. The coronavirus is more dangerous to the elderly and those with certain pre-existing medical conditions which is precisely the profile of lung cancer patients. Essential cancer services should be delivered but all steps should be taken to protect patients and the health workforce from infection with COVID-19. This presents a major challenge to radiotherapy (RT) departments worldwide. An international panel with expertise in the management of lung cancer in high-volume comprehensive centres has come together to share its experience on COVID-19 preparedness to deliver optimal care in such exceptional circumstances. A comprehensive systematic review of the literature through a PubMed search was undertaken. Twelve recommendations including, among others, the consideration of shorter courses, delays, and the omission of RT for lung cancer are proposed by the panel. In summary, we recommend the screening of every single person accessing the treatment room, the consideration of hypofractionation and to delay postoperative RT for non-small cell lung cancer, to avoid twice-daily treatments and delay or deliver prophylactic cranial irradiation during radio(chemo)therapy for limited-stage small cell lung cancer, review image guided RT images for suspicious image findings, and the use of single-fraction RT for the palliative treatment of stage IV lung cancer patients. Given that lung cancer is one of the most common and severe pathologies in radiation oncology departments, the following recommendations require particularly urgent consideration. The decision-making paths strongly depend on locally available resources, and a tailored approach should be used to attend lung cancer patients during this pandemic.

Severity of COVID-19 in patients with lung cancer: evidence and challenges

“… 43 Additional recommendations have included avoiding twice daily radiation, the use of single fraction radiation in the palliative setting, and the delay or omission of prophylactic cranial irradiation for patients with SCLC. 44 …”

COVID-19 safe and fully operational radiotherapy: An AIRO survey depicting the Italian landscape at the dawn of phase 2

“…The reduction of registered daily cases is imputable to the strict safety measures adopted and not to the decrease in number of treated patients. On the contrary, with the advent of P2, RT Directors globally reported a progressive realignment with the pre COVID-19 era workload for both outpatient and clinical activities, with a partial or complete reactivation of the previously interrupted or postponed treatments, also thanks to the several guidelines published to help clinicians coping with the novel pandemic scenario [5][6][7][8][9][10][11][12][13][14][15][16][17]. Therefore, the present survey demonstrated how the planned pro- gressive return to a novel routine during P2 has been attained by most Italian RT centres, maintaining high safety standards against a possible new spread of the infection and registering a lower number of positives cases among both patients and health professionals despite the resumption of a pre COVID-19 era workload.…”

GOECP/SEOR radiotherapy guidelines for small-cell lung cancer

“…SABR treatment options include 60 Gy delivered in 3 fractions, 48 Gy in 4 fractions, and 50 Gy in 5 fractions for peripheral lesions. Doses of 40-45 Gy in 15 daily fractions or 50-55 Gy in 20-25 daily fractions are potential alternative treatment schemes during periods such as the recent COVID-19 pandemic[ 101 , 174 ] (level of evidence III, grade of recommendation D).…”