Prospects of accelerated fractionation chemoradiotherapy for locally advanced oropharyngeal cancer during the COVID-19 pandemic.

Objective. To comparatively assess the early toxicity of treatment, its tolerability, 1-, 2-, 3-year overall survival, and local regional control rates in a group of patients receiving a radical cycle of accelerated or conventional fractionation chemoradiotherapy. Subjects and methods. The paper presents the interim results of a prospective study that included 115 patients with locally advanced cancer of the oropharynx, tongue root, and larynx who received a radical cycle of conformal chemoradiotherapy using accelerated (the single focal dose (SFD) was 2.4 Gy for 25-26 fractions) or conventional (SFD was 2.0 Gy for 32-33 fractions) fractionation in the period from 2015 to 2020. Results. An analysis comparing the study group with the control one revealed no statistically significant differences in the level of early toxicity of treatment (p=0.41). Complete tumor reversal was achieved in 57 (86.3%) patients in the study group and in 39 (79.5%) in the comparison group (p=0.23). The 1-, 2-, and 3-year local regional control rates in the accelerated fractionation group was 78.3+/-5.3%;65.9+/-6.8%, and 54.5+/-9.2%, respectively. The 3-year overall survival rate was 80.4+/-7.4%. These rates did not differ statistically from those in the conventional radiotherapy group (p=0.12-0.82);53 (80.3%) patients in the study group and 37 (75.5%) in the standard fractionation group received a radiation cycle without a forced interval. The treatment interval in the patients of both groups reduced the 2-year local regional control rates by 30.2% compared to that in the continuous cycle group (p=0.02). Conclusion. Accelerated fractionation chemoradiotherapy (SFD was 2.4 Gy for 25-26 fractions, the daily focal dose was 60.0- 62.4 Gy) is a procedure comparable with conventional radiation in its direct efficiency and safety. During the COVID-19 pandemic, this regimen can be considered to be a mainstay for patients with locally advanced oropharyngeal cancer in order to preserve the previous volumes of specialized healthcare.Copyright © A.V. SEMENOV I.A. GULIDOV O.G. LEPILINA M.U. RADZHAPOVA F.E. SEVRYUKOV K.B. GORDON.

Characteristic of Viral and Bacterial Contaminationin Objects of the Infection Hospital Environment of the Hospital for the Treatment of Patients with COVID-19 During the Pandemic Period

Relevance. Due to the COVID-19 pandemic a infectious diseases hospitals nationwide network has been deployed to treat patients infected with SARS-CoV-2. The principles of their formation with a strict division into «infectious» and «clean» zones, despite the epidemiological justification, lead to the formation of a dynamic artificially created closed ecosystem. In such an ecosystem, on the one hand, patients who undergo a wide range of invasive and aggressive therapeutic and diagnostic manipulations, and medical personnel stay for a long time, on the other hand, pathogens of a viral and bacterial nature that can adapt to hospital conditions and form resistant strains circulate. As a result, high risks of contamination of environmental objects of hospitals and patients themselves are created, which can lead to the development of exogenous nosocomial infection. Aims. To study the features of viral and bacterial contamination of objects in the hospital environment of the infectious diseases hospital for the treatment of patients infected with SARS-CoV-2 during the COVID-19 pandemic. Materials and methods. A study was conducted on 343 samples from the external environment of the infectious diseases hospital for COVID-19 patients' treatment during its planned work. Sample collection was performed during three days (Tuesday, Thursday, Sunday) at 20 unified sampling points: in the area where patients general hospital area as well as from the outer surface of personal protective equipment for medical personnel (overalls, gloves). The study used epidemiological (descriptive-evaluative and analytical), molecular genetic (SARS-CoV-2 PCR-RT, sequencing), bacteriological (isolation, cultivation and MALDI-TOF identification of bacterial cultures) methods. Statistical significance of differences was assessed by Fisher's point test (φ). Differences were considered significant at p≤0.05. Statistical data processing was carried out using the Microsoft Office 2010 application package, the online resource https://medstatistic. ru/, ST Statistica 10. Results. The study demonstrated a high level of viral and bacterial contamination of environmental objects in the intensive care unit of the infectious diseases hospital for COVID-19 patients treatment – 11.1%, incl. objects of the general hospital environment – 9.3% (doctor's workplace – 16.7%);patient location area – 13.9% (electric pump – 27.8%, mechanical ventilation, manipulation table – 16.7% each);the outer surface of personnel gloves – 21.1–38.9%;the outer surface of protective overalls for personnel – 44.4–50.0%. SARS-CoV-2 isolated from the objects of the external environment of the hospital belonged to the genetic variant B.1.617.1 DELTA, which corresponded to the epidemiological situation at sampling collection period. The opportunistic microflora structure was dominated by Enterococcus faecalis (38.1%), Klebsiella pneumoniaе (21.4%) and Escherichia coli (16.7%), which demonstrated a high level of resistance (to 3 or more groups of antibiotics). Conclusion. Initially, the main sources of the infectious diseases hospital environmental objects contamination with SARS-CoV-2 are most likely patients. Further contamination of the infectious diseases hospital environmental objects with viruses and opportunistic microflora occurs with the medical personnel direct participation. The current situation requires a review of approaches to the rules for disinfection, the PPE use and employees hands antiseptic treatment in infectious diseases hospital during the COVID-19 pandemic, as well as the length of staff work period length. © 2022, Numikom. All rights reserved.

Prospects of accelerated fractionation chemoradiotherapy for locally advanced oropharyngeal cancer during the COVID-19 pandemic

Objective. To comparatively assess the early toxicity of treatment, its tolerability, 1-, 2-, 3-year overall survival, and local regional control rates in a group of patients receiving a radical cycle of accelerated or conventional fractionation chemoradiotherapy. Subjects and methods. The paper presents the interim results of a prospective study that included 115 patients with locally advanced cancer of the oropharynx, tongue root, and larynx who received a radical cycle of conformal chemoradiotherapy using accelerated (the single focal dose (SFD) was 2.4 Gy for 25—26 fractions) or conventional (SFD was 2.0 Gy for 32—33 fractions) fractionation in the period from 2015 to 2020. Results. An analysis comparing the study group with the control one revealed no statistically significant differences in the level of early toxicity of treatment (p=0.41). Complete tumor reversal was achieved in 57 (86.3%) patients in the study group and in 39 (79.5%) in the comparison group (p=0.23). The 1-, 2-, and 3-year local regional control rates in the accelerated fractionation group was 78.3±5.3%;65.9±6.8%, and 54.5±9.2%, respectively. The 3-year overall survival rate was 80.4±7.4%. These rates did not differ statistically from those in the conventional radiotherapy group (p=0.12—0.82);53 (80.3%) patients in the study group and 37 (75.5%) in the standard fractionation group received a radiation cycle without a forced interval. The treatment interval in the patients of both groups reduced the 2-year local regional control rates by 30.2% compared to that in the continuous cycle group (p=0.02). Conclusion. Accelerated fractionation chemoradiotherapy (SFD was 2.4 Gy for 25—26 fractions, the daily focal dose was 60.0— 62.4 Gy) is a procedure comparable with conventional radiation in its direct efficiency and safety. During the COVID-19 pandemic, this regimen can be considered to be a mainstay for patients with locally advanced oropharyngeal cancer in order to preserve the previous volumes of specialized healthcare. © A.V. SEMENOV I.A. GULIDOV O.G. LEPILINA M.U. RADZHAPOVA F.E. SEVRYUKOV K.B. GORDON.

Lessons to learn: COVID-19 epidemic in Italy

Here we provide the assessment of COVID-19 epidemic in Italy, which scale has led to serious challenges both for society and national health care system. Despite timely information regarding the pandemic spread of the novel coronavirus infection, the country's health care was not prepared to dramatically increased rate of patients with viral pneumonia at the first stage of the epidemic, infection control measures were not fully implemented that also led to spread of infection among health care workers. Socially vulnerable population groups did not seek timely medical care due to the lack of hospital facilities as well as well-trained medical personnel. At the second stage of developing epidemic, were also delayed and executed at varying timepoints in neighbor regions, with sustained insufficient management after implementing them that was reflected as ongoing rise of epidemic curve over long time. Delayed execution of anti-epidemic restrictive measures aimed at fighting against ongoing epidemic resulted in substantially increased morbidity and mortality among vulnerable population groups and retarded rate of decreasing COVID-19 epidemic curve. Analyzing response measures taken in Italy against COVID-19 epidemic should be appreciated by other countries while dealing with the current pandemic and preparing to react to novel biological threats in the future.

BORN IN WUHAN: LESSONS FROM COVID-19 EPIDEMIC IN CHINA

The COVID-19 epidemic curve in China can be divided into several stages. Despite transparency in informing the world public about clusters of undiagnosed viral pneumonia, the country's health care at the first stage of the epidemic was not ready to provide adequate and rapid response for a fast increase in the number of patients with COVID-19, infection control measures were not fully implemented, which also led to a large number of nosocomial cases of infection among medical workers and patients. Socially vulnerable groups of the population did not refer for medical assistance in a timely manner due to the lack of the disease danger understanding and also in connection with the high cost for them of medical aid. At the second stage, simultaneously with the restrictive measures introduced by the government, the entire health care system was rebooted: free medical care for patients with COVID-19 was provided and the strictest infection control measures were implemented, multi-level contact tracking system using IT technologies was organized, and the capacity of hospitals was increased many times. Through the joint efforts of ministries, mass media, social networks and volunteer movements, an unprecedented social mobilization of the population was achieved. Strict implementation of the entire set of measures aimed at fighting the epidemic allowed to take it under strict control at the third stage and practically eliminate the epidemic after 2,5 months. China's response to the COVID-19 epidemic can be useful to other countries, in fighting the current pandemic and in preparing for a response to biological threats in the future.