ABSTRACT
Background: COVID-19 pandemic led to a drastical rearrangement within healthcare staff and facilities. Due to its high incidence, management of breast cancer (BC) was particularly critical during the COVID-19 pandemic, and the reduction of healthcare staff and facilities influenced the timing in BC care. The aim of the present report was to analyze the timing from diagnosis to surgery, from diagnosis to radiotherapy (RT) start and from surgery to RT start during the COVID-19 pandemic. Method(s): We retrospectively collected data of women with BC treated with Radiotherapy (RT) after surgery at our Institution (Department of Oncology, Radiation Oncology, S. Anna Hospital, Turin, Italy), during the COVID-19 pandemic. To evaluate patients' data according to the different stages of the pandemic, we identified 4 periods: first wave (FW), first reopening (FR), second wave (SW) and second reopening (SR). Among the 4 periods, we divided patients in 2 groups: patients who underwent adjuvant chemotherapy (CT) before RT (CT-group), and those who received exclusive adjuvant RT (non-CT group). Result(s): from early March 2020 to 31 March 2022, 464 patients were treated. After patients' selection, data from 390 patients were analyzed. Overall, the average interval between biopsy and RT in the non-CT group was 202 days during the FW (101-386), 172 days (85-242) during the FR, 136 days (69-366) during the SW, 159 days (77-455) during the SR. In the CT group, the average interval from biopsy to RT start was 337 days (224-495) during the FW, 277 days (209-496) during FR, 297 days (220-419) during the SW, and 261 days (169-447) during the SR. Conclusion(s): we reported our experience during these two years of the pandemic and how COVID-19 impacted the timing of the management of patients with BC. Overall, during the viral waves there was a remarkable increase in the interval between biopsy/surgery and RT. Nonetheless, we managed to keep optimal BC care and favorable interval trends were observed with reopening phases. Copyright: © 2022 The Author(s).
ABSTRACT
Background: The COVID-19 pandemic had a catastrophic impact on healthcare. Keeping an optimal cancer care routine has been challenging. For cervical cancer (CC) patients external beam radiotherapy (EBRT) and brachytherapy (BT) are key elements for radical treatment. Oncological treatment delays have represented a major issue during the pandemic. Overall treatment time (OTT) is a well-known prognostic factor for CC. Thus, we decided to evaluate radiotherapy timing and modalities, and OTT trends for locally advanced cervical cancer (LACC) patients treated at our center during the Pandemic. Method(s): We retrospectively collected and analyzed data of patients treated for LACC at our Center, (Department of Oncology, Radiation Oncology, S.Anna Hospital, Turin, Italy), during the COVID-19 pandemic. Result(s): Between March 2020 and March 2022, 36 patients were treated. All patients underwent EBRT (median pelvic dose 48 Gray (Gy)). Concurrent chemotherapy (ChT) was administered in 31/36 patients. High Dose Rate (HDR) BT boost was delivered to 32/36 patients. BT schedules adopted were: 28 Gy in 4 fractions (18 cases, 56.2%), 26 Gy in 4 fractions (5 cases, 15.6%), 21 Gy in 3 fractions (4 cases, 12.5%), 18 Gy in 3 fractions (3 cases, 9.3%), 24 Gy in 4 fractions (one case, 3.2%), 12 Gy in 2 fractions plus 11 Gy in 2 fractions (one case, 3.2%). Most of the patients (25/32, 78.1%) received one fraction per week;6 patients (18.1%) 2 fractions per week and one patient 3 fractions per week. Median OTT was 74 days (57-99). The median interval from EBRT to HDR-BT was 14 days (6-54). Four patients tested positive for COVID-19 between EBRT and BT. At a median follow-up of 10.7 months (range 1.8-20.3), a complete response was obtained in 25 patients (69.5%), a partial response in 8 cases (22.2%), and a disease progression in two patients (5.5%). Conclusion(s): in terms of radiotherapy management of LACC, brachytherapy resulted as the most affected by the restrictions due to the pandemic. We adopted different schedules and fractionations to optimize the resources available and to keep providing an optimal care. A be-weekly fractionation emerged as a promising option for LACC during the pandemic, with a good toxicity profile. Copyright: © 2022 The Author(s).