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

Autor:	Guckenberger M; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland. Electronic address: Matthias.Guckenberger@usz.ch., Belka C; Department of Radiation Oncology, LMU Klinikum, LMU Munich, Germany., Bezjak A; Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Canada., Bradley J; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA., Daly ME; Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, USA., DeRuysscher D; Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center(+), GROW Research Institute, The Netherlands., Dziadziuszko R; Dept. of Oncology and Radiotherapy, Medical University of Gdansk, Poland., Faivre-Finn C; Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK., Flentje M; Department of Radiation Oncology, University Hospital Würzburg, JMU Würzburg, Germany., Gore E; Department of Radiation Oncology, Medical College of Wisconsin and Zablocki VAMC, Milwaukee, USA., Higgins KA; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA., Iyengar P; Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, USA., Kavanagh BD; Department of Radiation Oncology, University of Colorado, Aurora, USA., Kumar S; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA., Le Pechoux C; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France., Lievens Y; Department of Radiation Oncology, Ghent University Hospital and Ghent University, Belgium., Lindberg K; Department of Head, Neck, Lung and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden., McDonald F; Royal Marsden Hospital, London, UK., Ramella S; Radiation Oncology, Campus Bio-Medico University of Rome, Italy., Rengan R; Department of Radiation Oncology, University of Washington School of Medicine, Seattle, USA., Ricardi U; Department of Oncology, University of Turin, Italy., Rimner A; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA., Rodrigues GB; Division of Radiation Oncology, Western University, London, Canada., Schild SE; Department of Radiation Oncology, Mayo Clinic, Phoenix, USA., Senan S; Department of Radiation Oncology, Amsterdam UMC, The Netherlands., Simone CB 2nd; Department of Radiation Oncology, New York Proton Center and Memorial Sloan Kettering Cancer Center, USA., Slotman BJ; Department of Radiation Oncology, Amsterdam UMC, The Netherlands., Stuschke M; Department of Radiotherapy, University Duisburg-Essen, Germany., Videtic G; Department of Radiation Oncology, Cleveland Clinic Lerner College of Medicine of Case Western University, USA., Widder J; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria., Yom SS; Department of Radiation Oncology, University of California San Francisco, USA., Palma D; Division of Radiation Oncology, Western University, London, Canada.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2020 Jul 15; Vol. 107 (4), pp. 631-640.
DOI:	10.1016/j.ijrobp.2020.05.012
Abstrakt:	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. (Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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