Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

Abstract

Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dosefractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic.Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/ 03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should

Expectations of therapeutic radiography students in Wales about transitioning to practice during the Covid-19 pandemic as registrants on the HCPC temporary register

“…Rapidly amended treatment protocols recommend new treatment prescriptions 1 and working patterns that seek to balance health risks to patients and staff with an optimal allocation of NHS resources. 2 Radiotherapy services are anticipating extreme demand pressure from a significant patient backlog 3 caused by restrictions of upstream diagnostic oncology services, treatment options and uptake by service users during the first wave of the pandemic. 4…”

Radiotherapy and COVID-19 pandemic - a review of the current recommendations

“…When concurrent radiochemotherapy is planned for stage III NSCLC, it should not be applied hypofractionated radiotherapy [20]. Faivre-Finn et al proposed stereotactic ablative radiotherapy (SABR) for early stage NSCLC but with other specific limitations about tumor size and depending on the distance from the chest wall [22]. Fractionation and dose schedules vary from 30-34 Gy in 1 fraction to 48-54 Gy in 3 fractions [22].…”

“…Faivre-Finn et al proposed stereotactic ablative radiotherapy (SABR) for early stage NSCLC but with other specific limitations about tumor size and depending on the distance from the chest wall [22]. Fractionation and dose schedules vary from 30-34 Gy in 1 fraction to 48-54 Gy in 3 fractions [22]. For central tumours, hypofractionated regimen is considered with a dose of 50-60 Gy in 15 fractions [22].…”

“…Fractionation and dose schedules vary from 30-34 Gy in 1 fraction to 48-54 Gy in 3 fractions [22]. For central tumours, hypofractionated regimen is considered with a dose of 50-60 Gy in 15 fractions [22].…”

Hypofractionated Accelerated Concurrent Chemoradiotherapy in Inoperable Stage III Non-small Cell Lung Cancer: SOCCAR. A Large Single-Centre Experience

“…Madam — Recent Royal College of Radiologists' treatment guidelines for lung cancer during the COVID-19 pandemic [ 1 ] motivated us to share the findings of our recent audit of accelerated hypofractionated concurrent chemoradiotherapy in inoperable stage III non-small cell lung cancer (NSCLC; SOCCAR regimen): 55 Gy in 20 fractions over 26 days with concomitant chemotherapy (cisplatin and vinorelbine) [ 2 ].…”