Radiation Therapy Delivery Challenges in Older Patients During Coronavirus Disease 2019 Pandemic

Abstract

Purpose The management of elderly patients in radiotherapy (RT) departments has been challenging in the context of the Coronavirus 19 (Covid-19) outbreak. We report our experience of RT adapted schedules or strategy changes in older patients during the Covid-19 pandemic. Methods and Materials Patients aged ≥75 years were recruited during weekly chart rounds. All were potentially eligible for a specific intervention to reduce the frequency of patients’ visits to the hospital. The impact of deferring radiation and hypofractionation of RT schedules was assessed in terms of the number of courses initially planned and re-planned during the lockdown. Results Twenty patients were identified during the official lockdown in France (March 17 to May 11). Median age was 78y (75-95y). Most patients were male (n=12, 60%) being treated in the postoperative setting (n=17, 85%). RT was delayed in 11 cases (55%) with hormonal therapy prescribed in 10 cases (50%). Altered RT fractionation was proposed for five cases (25%) combinations of altered fractionation and deferral of radiation were applied in three cases (15%). The number of radiation courses initially planned and re-planned according to the pandemic context: 563 and 197 respectively (-62%; p<0.001). None presented recurrence when RT was initiated, and no patient developed symptomatic Covid-19 infection. Conclusions In the context of the Covid-19 outbreak, individual risk-based radiation therapy seems to be safe. Systematic screening of patients for Covid-19 before starting radiotherapy is mandatory. In our department the oncogeriatrics expertise availability for daily practice was of great use during the pandemic. Other prospective studies are needed to validate such strategies in case of resurgence of similar outbreaks.