Practice Recommendations for Risk-Adapted Head and Neck Cancer Radiation Therapy During the COVID-19 Pandemic: An ASTRO-ESTRO Consensus Statement

Abstract

Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff. Methods and Materials: A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (!80%) and agreement (!66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases. Results: In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care. Conclusions: This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure highquality HNC treatments continue, to save lives and for symptomatic benefit.

Oncological care organisation during COVID-19 outbreak

“…8 Several recent expert statements have been published addressing how to manage care in specialist oncology departments, but few reports guide effective organisation for daily clinical practice. [9][10][11][12][13][14][15][16][17][18][19][20] We aimed to assess how oncology centres and departments reacted to the health crisis related to the COVID-19 pandemic, in order to improve oncological care and to implement preventive measures.…”

Strategies to Maximize Available Resources With Minimum Cost Escalation for Improving Radiation Therapy Accessibility in the Post–Coronavirus Disease 2019 Era: An Analysis for Asia

“…Presently HFRT has been successfully used in a wide range of disease sites and similar efficacy without any significantly added acute or late morbidities and hence it has been recommended during the COVID-19 pandemic resource constraints. 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 The HFRT dose-fractionation schedules could be further adapted depending on the clinical situation as has been recently proposed for head and neck cancers jointly by ASTRO-ESTRO 36 . The BEDs for early and late effects of the mild to moderate HFRT regimes evaluated in the present study are marginally higher than those of SFRT at 2Gy/fraction and therefore could be safely implemented in routine clinical practice.…”

COVID-19 and Radiation Oncology: a 2-phase planning in a mono-institutional experience in Central Italy

“…No positive or suspicious cases were found in our experience both in phase I and in phase II. However, the difference on the reduction of workloads and on the number of positive or suspect patients reported in the national survey consists in the predominance of the COVID-19 cases in the regions of northern Italy and in particular in Lombardy where 10-50% reduction in radiotherapy workloads has been registered, but also in greater organizational awareness due to the increase of national and international guidelines emerging in the meantime in the literature and in the detailed recommendations on the individual tumor pathologies treated in terms of use of hypofractionated regimens [22][23][24][25][26]. In our experience, dose hypofractionation has been used in breast, prostate and palliation cancers.…”