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Author Notes:

Correspondence: Sue S. Yom, sue.yom@ucsf.edu

The authors thank Anne W.M. Lee, MD, of the University of Hong Kong; Jean Bourhis, MD, PhD, of the University of Lausanne; Joseph T.S. Wee, MD, PhD, of the National Cancer Centre Singapore; Cai Grau, MD, DMSc, of Aarhus University; Louis Harrison, MD, of the Moffitt Cancer Center;

Hisham Mehanna, PhD, FRCS, of the Head and Neck International Group; Thomas Eichler, MD, and Laura Dawson, MD, of ASTRO; and Ben Slotman, MD, PhD, and Umberto Ricardi, MD, of ESTRO, for their support and advice on dissemination of this research.

Disclosures: D.B. reports other from ASTRO, UpToDate, and Sanofi-Celgene outside the submitted work; J.C. reports grants and personal fees from Varian Medical Systems outside the submitted work;

KH. reports grants and personal fees from AstraZeneca, personal fees from BMS, grants and personal fees from Boehringer-Ingelheim, personal fees from Merck Serono, grants and personal fees from MSD, personal fees from Pfizer, and grants and personal fees from Replimune outside the submitted work;

S.K. reports grants from Merck, grants from BMS, and personal fees from UpToDate outside the submitted work; J.A.L. reports grants, personal fees, and nonfinancial support from IBA, grants and nonfinancial support from RaySearch, nonfinancial support from Siemens, and grants and nonfinancial support from Mirada Medical outside the submitted work;

Q.T.L. reports being a Merck scientific advisory committee member and Pfizer DSMB member outside the submitted work;

N.L. reports grants and personal fees from Pfizer, grants and personal fees from Merck, grants from Astra Zeneca, grants and personal fees from Merck Serono, personal fees from Sanofi Aventis, personal fees from Lilly, personal fees from UpToDate, and a patent SK2016-129-01 issued outside the submitted work;

W.B. reports personal fees from MSD, personal fees from BMS, personal fees from Pfizer, and personal fees from Merck outside the submitted work;

S.S.Y. reports grants from Genentech, Bristol-Myers Squibb, Merck, and BioMimetix and personal fees from Springer and UpToDate outside the submitted work.

Subject:

Research Funding:

None declared

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Radiology, Nuclear Medicine & Medical Imaging
  • Squamous cell carcinoma

Practice recommendations for risk-adapted head and neck cancer radiotherapy during the COVID-19 pandemic: An ASTRO-ESTRO consensus statement

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Journal Title:

Radiotherapy and Oncology

Volume:

Volume 151

Publisher:

, Pages 314-321

Type of Work:

Article | Final Publisher PDF

Abstract:

Purpose: Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff. Methods and Materials: A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases. Results: In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care. Conclusions: This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.

Copyright information:

© 2020 The Authors. Published by Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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