ABSTRACT
Background and purpose: : To develop the safest possible environment for treating urgent COVID+ patients, we describe the unique construction of negative air pressure CT simulator and treatment vaults in addition to screening, delay and treatment protocols and their evolution over the course of the COVID pandemic. Materials and methods: Construction of large HEPA filter air flow systems into existing ductwork in CT simulator rooms and photon and proton treatment vaults was attempted to create negative pressure rooms. An asymptomatic COVID screening protocol was implemented for all patients prior to initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from 6/2020 to 1/2022 were retrospectively reviewed. Results: Negative airflow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from 6/2020 through 1/2022 across 5 separate centers. The majority of COVID positive patients had treatment deferred when deemed safe. A total of 42 COVID positive patients who were at highest risk were treated under the COVID-19 biocontainment protocol, in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority (64.3%) of patients were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range: 1-15), prior to COVID clearance and resumption of treatment in a normal air flow environment. Conclusion: Constructing negative pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of COVID positive radiation oncology patients within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.
ABSTRACT
Background and purpose : To develop the safest possible environment for treating urgent COVID+ patients, we describe the unique construction of negative air pressure CT simulator and treatment vaults in addition to screening, delay and treatment protocols and their evolution over the course of the COVID pandemic. Materials and methods Construction of large HEPA filter air flow systems into existing ductwork in CT simulator rooms and photon and proton treatment vaults was attempted to create negative pressure rooms. An asymptomatic COVID screening protocol was implemented for all patients prior to initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from 6/2020 to 1/2022 were retrospectively reviewed. Results Negative airflow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from 6/2020 through 1/2022 across 5 separate centers. The majority of COVID positive patients had treatment deferred when deemed safe. A total of 42 COVID positive patients who were at highest risk were treated under the COVID-19 biocontainment protocol, in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority (64.3%) of patients were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range: 1-15), prior to COVID clearance and resumption of treatment in a normal air flow environment. Conclusion Constructing negative pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of COVID positive radiation oncology patients within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.
ABSTRACT
OBJECTIVE: To develop expert consensus recommendations regarding radiation therapy for gynecologic malignancies during the COVID-19 pandemic. METHODS: An international committee of ten experts in gynecologic radiation oncology convened to provide consensus recommendations for patients with gynecologic malignancies referred for radiation therapy. Treatment priority groups were established. A review of the relevant literature was performed and different clinical scenarios were categorized into three priority groups. For each stage and clinical scenario in cervical, endometrial, vulvar, vaginal and ovarian cancer, specific recommendations regarding dose, technique, and timing were provided by the panel. RESULTS: Expert review and discussion generated consensus recommendations to guide radiation oncologists treating gynecologic malignancies during the COVID-19 pandemic. Priority scales for cervical, endometrial, vulvar, vaginal, and ovarian cancers are presented. Both radical and palliative treatments are discussed. Management of COVID-19 positive patients is considered. Hypofractionated radiation therapy should be used when feasible and recommendations regarding radiation dose, timing, and technique have been provided for external beam and brachytherapy treatments. Concurrent chemotherapy may be limited in some countries, and consideration of radiation alone is recommended. CONCLUSIONS: The expert consensus recommendations provide guidance for delivering radiation therapy during the COVID-19 pandemic. Specific recommendations have been provided for common clinical scenarios encountered in gynecologic radiation oncology with a focus on strategies to reduce patient and staff exposure to COVID-19.