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

ชื่อผู้แต่ง : Matthias Guckenberger, Claus Belka, Andrea Bezjak, Jeffrey Bradley, Megan E. Daly, Dirk DeRuysscher, Rafal Dziadziuszko, Corinne Faivre-Finn, Michael Flentje, Elizabeth Gore, Kristin A. Higgins, Puneeth Iyengar, Brian D Kavanagh, Sameera Kumar, Cecile Le Pechoux, Yolande Lievens, Karin Lindberg, Fiona McDonald, Sara Ramella, Ramesh Rengan, Umberto Ricardi, Andreas Rimner, George B. Rodrigues, Steven E. Schild, Suresh Senan, Charles B. Simone II, Ben J. Slotman, Martin Stuschke, Greg Videtic, Joachim Widder, Sue S. Yom, David Palma

สำนักพิมพ์ : ELSEVIER

เนื้อหาโดยย่อ : 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 the consensus process using a modified Delphi process. We assessed potential adaptations of radiotherapy in two pandemic scenarios. The first, the 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 our radiotherapy staff. The second, a later pandemic scenario, is characterized by reduced radiotherapy resources. 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 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.