ABSTRACT
Background: The pandemic raised a discussion about postponement of medical interventions for lung cancer. We analyzed the special characteristics of pretreatment diagnostic assessment in the pandemic and the influence of diagnostic assessment on outcomes. Method(s): A total of 96 patients with stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) were included. We compared characteristics in the pre-COVID era (2012-2019) and characteristics in the COVID era (2020-2021). We analyzed whether pretreatment diagnostic assessment and the time from assessment to SBRT initiation had an influence on outcomes. Result(s): The number of patients per month with SBRT was higher in the COVID era (mean 1.5) than in the pre-COVID era (mean 0.9) (p=0.04). In the COVID era, we found longer times from the planning CT scan to the initiation of SBRT (p<0.001, mean, 3.0 vs. 1.7 weeks). Patients who received a pretreatment PET/CT scan (n=83) experienced better overall survival (p=0.02, 2 years, 61% vs. 29%) than patients who underwent conventional staging (n=13). A longer time from the PET/CT scan to the initiation of SBRT (<10 vs. >=10 weeks) was associated with worse locoregional control (p=0.01, 2 years, 97% vs. 70%). Discussion(s): The pandemic raised the question whether medical interventions can safely be postponed. At the same time, patients are at risk of tumor progression. Lung SBRT can be performed as an outpatient procedure with less close contacts. The preference to refer patients to SBRT might explain the increase in patients treated in the COVID era. The longer times from the planning CT scan to SBRT might reflect the efforts to slow the virus spread. Our study points out that efforts should be made to obtain a PET/CT scan close to SBRT. Conclusion(s): The findings on special characteristics of management during the COVID era might serve as a basis to guide strategies in similar future scenarios. The postponement of interventions should be carefully discussed with consideration of an accurate and timely staging workup.
ABSTRACT
The immunopathogenesis of COVID-19 remains ill-defined. Through hyperstimulation of the immune system, SARS-CoV2 may cause a multi-facetted inflammatory disease and generate immune-mediated organ damage even leading to fatal consequences. However, it is still unclear, if a modified course of COVID-19 occurs in patients with autoimmune and/or autoinflammatory diseases.