Practice Recommendations for Lung Cancer Radiotherapy During the COVID-19 Pandemic: An ESTRO-ASTRO Consensus Statement

• Type of Material: Article
• Authors: Matthias Guckenberger, University of Zurich; Claus Belka, Ludwig Maximilians Univ Munchen; Andrea Bezjak, University of Toronto; Jeffrey Bradley, Emory University; Megan E Daly, University of California Davis; Dirk DeRuysscher, Maastricht University; Rafal Dziadziuszko, Medical University Gdansk; Corinne Faivre-Finn, University of Manchester; Micheal Flentje, University Hospital Würzburg, JMU Würzburg; Elizabeth Gore, Med Coll Wisconsin & Zablocki VAMC; Kristin Higgins, Emory University; Puneeth Iyengar, UT Southwestern Medical Center, Dallas; Brian D Kavanagh, University of Colorado, Aurora; Sameera Kumar, Fox Chase Cancer Center, Philadelphia; Cecile Le Pechoux, Gustave Roussy Cancer Campus, Villejuif; Yolande Lievens, Ghent University Hospital; Karin Lindberg, Karolinska University Hospital; Fiona McDonald, Royal Marsden Hospital; Sara Ramella, Campus Biomed University Rome; Ramesh Rengan, University of Washington; Umberto Ricardi, University of Turin; Andreas Rimner, Mem Sloan Kettering Cancer Centre; George B Rodrigues, Western University, London, Canada; Steven E Schild, Mayo Clinic, Phoenix; Suresh Senan, Amsterdam UMC; Charles B Simone, New York Proton Center and Memorial Sloan Kettering Cancer Center; Ben J Slotman, Amsterdam UMC; Martin Stuschke, University of Duisburg Essen; Greg Videtic, Case Western University; Joachim Widder, Medical University of Vienna; Sue S Yom, University of California San Francisco; David Palma, Western University, London, Canada
• Language: English
• Date: 2020-07-15
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Author(s)
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijrobp.2020.05.012
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
• Volume: 107
• Issue: 4
• Start Page: 631
• End Page: 640
• Grant/Funding Information: See "Conflict of interest disclosures"
• Keywords: RADIATION-THERAPY; Radiology, Nuclear Medicine & Medical Imaging; Science & Technology; NSCLC; SINGLE; Oncology; RANDOMIZED-TRIAL; Life Sciences & Biomedicine
• Research Categories: Chemistry, Radiation; Health Sciences, Oncology

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.