TY - JOUR
T1 - Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic
T2 - An ESTRO-ASTRO consensus statement
AU - Guckenberger, Matthias
AU - Belka, Claus
AU - Bezjak, Andrea
AU - Bradley, Jeffrey
AU - Daly, Megan E.
AU - DeRuysscher, Dirk
AU - Dziadziuszko, Rafal
AU - Faivre-Finn, Corinne
AU - Flentje, Michael
AU - Gore, Elizabeth
AU - Higgins, Kristin A.
AU - Iyengar, Puneeth
AU - Kavanagh, Brian D.
AU - Kumar, Sameera
AU - Le Pechoux, Cecile
AU - Lievens, Yolande
AU - Lindberg, Karin
AU - McDonald, Fiona
AU - Ramella, Sara
AU - Rengan, Ramesh
AU - Ricardi, Umberto
AU - Rimner, Andreas
AU - Rodrigues, George B.
AU - Schild, Steven E.
AU - Senan, Suresh
AU - Simone, Charles B.
AU - Slotman, Ben J.
AU - Stuschke, Martin
AU - Videtic, Greg
AU - Widder, Joachim
AU - Yom, Sue S.
AU - Palma, David
N1 - Funding Information:
M. Daly: Research funding from EMD Serono and Genentech, Boston Scientific Advisory Board, Triptych Health Partners consulting.
Publisher Copyright:
© 2020 The Author(s)
PY - 2020/5
Y1 - 2020/5
N2 - 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 radio-therapy 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 INSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radio-therapy 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-19infection. 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 con-sensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic.
AB - 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 radio-therapy 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 INSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radio-therapy 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-19infection. 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 con-sensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic.
KW - RADIATION-THERAPY
KW - TRIAL
U2 - 10.1016/j.radonc.2020.04.001
DO - 10.1016/j.radonc.2020.04.001
M3 - Article
C2 - 32342863
SN - 0167-8140
VL - 146
SP - 223
EP - 229
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -