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    Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: An ESTRO-ASTRO consensus statement

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    Authors
    Guckenberger, M
    Belka, C
    Bezjak, A
    Bradley, J
    Daly, ME
    De Ruysscher, D
    Dziadziuszko, R
    Faivre-Finn, Corinne
    Flentje, M
    Gore, E
    Higgins, KA
    Iyengar, P
    Kavanagh, BD
    Kumar, S
    Le Pechoux, C
    Lievens, Y
    Lindberg, K
    McDonald, F
    Ramella, S
    Rengan, R
    Ricardi, U
    Rimner, A
    Rodrigues, GB
    Schild, SE
    Senan, S
    Simone Ii, CB
    Slotman, BJ
    Stuschke, M
    Videtic, G
    Widder, J
    Yom, SS
    Palma, D
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    Affiliation
    Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
    Issue Date
    2020
    
    Metadata
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    Abstract
    Background: The COVID-19 pandemic has caused radiotherapy resource pressures and led to increased risks for lung cancer patients and healthcare staff. An international group of experts in lung cancer radiotherapy established this practice recommendation pertaining to whether and how to adapt radiotherapy for lung cancer in the COVID-19 pandemic. Methods: For this ESTRO & ASTRO endorsed project, 32 experts in lung cancer radiotherapy contributed to a modified Delphi consensus process. We assessed potential adaptations of radiotherapy in two pandemic scenarios. The first, an early pandemic scenario of risk mitigation, is characterized by an altered risk-benefit ratio of radiotherapy for lung cancer patients due to their increased susceptibility for severe COVID-19 infection, and minimization of patient travelling and exposure of radiotherapy staff. The second, a later pandemic scenario, is characterized by reduced radiotherapy resources requiring patient triage. Six common lung cancer cases were assessed for both scenarios: peripherally located stage I NSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radiotherapy and prophylactic cranial irradiation for limited stage SCLC and palliative thoracic radiotherapy for stage IV NSCLC. Results: In a risk-mitigation pandemic scenario, efforts should be made not to compromise the prognosis of lung cancer patients by departing from guideline-recommended radiotherapy practice. In that same scenario, postponement or interruption of radiotherapy treatment of COVID-19 positive patients is generally recommended to avoid exposure of cancer patients and staff to an increased risk of COVID-19 infection. In a severe pandemic scenario characterized by reduced resources, if patients must be triaged, important factors for triage include potential for cure, relative benefit of radiation, life expectancy, and performance status. Case-specific consensus recommendations regarding multimodality treatment strategies and fractionation of radiotherapy are provided. Conclusion: This joint ESTRO-ASTRO practice recommendation established pragmatic and balanced consensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic.
    Citation
    Guckenberger M, Belka C, Bezjak A, Bradley J, Daly ME, DeRuysscher D, et al. Practice Recommendations for Lung Cancer Radiotherapy During the COVID-19 Pandemic: An ESTRO-ASTRO Consensus Statement. Int J Radiat Oncol Biol Phys. 2020;107(4):631-40.
    Journal
    International Journal of Radiation Oncology Biology Physics
    URI
    http://hdl.handle.net/10541/623103
    DOI
    10.1016/j.ijrobp.2020.05.012
    PubMed ID
    32589990
    Additional Links
    https://dx.doi.org/10.1016/j.ijrobp.2020.05.012
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijrobp.2020.05.012
    Scopus Count
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