Changes in radical radiotherapy for lung cancer patients in the UK during the COVID-19 pandemic

Abstract

Purpose or Objective Lung cancer patients are at high risk of developing severe COVID-19. Therefore, in response to the COVID-19 pandemic, guidelines were published in the UK (Faivre-Finn et al, 2020) to advise on reduced dose fractionation regimens for curative-intent radiotherapy (RT) for lung cancer. This reduces the frequency of hospital visits and thus potential exposure to SARS-CoV-2. We present the changes that occurred in the UK in this study (COVID-RT-Lung). Materials and Methods COVID-RT-Lung is a prospective multicentre UK data collection study. Inclusion criteria include: stage 1 – 3 lung cancer (biopsy-proven or diagnosed on cross-sectional imaging) referred for and/or treated with curative-intent RT between 2/4/2020 – 2/10/2020. Both patients who had a change in their management and those who continue with standard management are included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, RT and systemic treatment, treatment-related toxicity, disease/patient status were collected. Each participating centre obtained local approval and anonymised data was collected on a central, cloud-based Research Electronic Data Capture system. Results 1352 patients from 28 UK sites were available for analysis on 25/01/2020. Median age 72 years (range 37 – 93), 675 (50.1%) male, and median PS 1 (range 0-3). 566 (42.1%) had stage 1 disease, 204 (15.2%) stage 2 and 574 (42.7%) stage 3. 812 (60.3%) had NSCLC, 140 (10.4%) had SCLC and 394 (29.3%) had a radiological diagnosis of lung cancer. 18 (1.3%) patients tested positive for SARS-CoV-2. 98 (7.3%) had RT instead of surgery. 231 (17.1%) patients had a change in their RT treatment from their local standard of care, the largest change (69 patients, 28.4%) was seen in May 2020. Monthly variation of changes in RT treatment compared to standard of care is demonstrated in Figure 1.Multivariable logistic regression against patient PS, age, number of comorbidities, respiratory comorbidities , cardiac comorbidities and stage found a better PS 0-1 was significantly associated with having a change in RT treatment compared to PS 2-3 (p = 0.00131). There was no significant association with the other variables. In patients with a change in RT treatment, there was an increase in hypofractionation, particularly the ˃3 – 5Gy/fraction group, and almost no ≤2Gy/fraction treatments delivered (Figure 2). Median number of fractions was 15 (range 1-36) in patients with a change in RT, and 20 (range 1-42) in patients with no change to treatment. Conclusion This multicentre UK study demonstrates that patients with stage 1-3 lung cancer had changes in curative-intent RT treatment according to UK guidelines. RT changes occurred more frequently in the earlier period of the COVID-19 pandemic and were more likely in patients with a better PS. Furthermore, an increase in hypofractionation was seen if RT treatment was changed. Data is being collected on disease recurrence and survival for future assessment of RT treatment changes on patient outcomes.