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

• Authors: Matthias Guckenberger, University of Zurich; Claus Belka, Ludwig Maximilians Universitat 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; Michael Flentje, University Hospital Wurzburg; Elizabeth Gore, Medical College of Wisconsin; Kristin Higgins, Emory University; Puneeth Iyengar, University of Texas MD Anderson Cancer Center; Brian D. Kavanagh, University of Colorado; Sameera Kumar, Fox Chase Cancer Center; Cecile Le Pechoux, Gustave Roussy Cancer Campus; Yolande Lievens, Ghent University Hospital; Karin Lindberg, Karolinska University Hospital; Fiona McDonald, Royal Marsden Hospital; Sara Ramella, Campus Bio-Medico University of Rome; Rengan Rengan, University of Washington; Umberto Ricardi, University of Turin; Andreas Rimner, Memorial Sloan Kettering Cancer Center; George B. Rodrigues, Western University; Steven E. Schild, Mayo Clinic; Suresh Senan, Amsterdam Universitair Medisch Centrum; Charles B. Simone, New York Proton Center; Ben J. Slotman, Amsterdam Universitair Medisch Centrum; Martin Stuschke, University of Duisburg Essen; Greg Videtic, Case Western Reserve University; Joachim Widder, Medical University of Vienna; Sue S. Yom, University of California San Francisco; David Palma, Western University
• Journal Title: Radiotherapy & Oncology
• Volume: Volume 146
• Publisher: Elsevier Ireland Ltd. | 2020-05-01, Pages 223-229
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.radonc.2020.04.001
• Subjects: Health Sciences, Oncology; Health Sciences, Radiology; Health Sciences, Rehabilitation and Therapy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Radiology, Nuclear Medicine & Medical Imaging; Radiation therapy; Trial

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.