ABSTRACT
Background: There is unanimous agreement that oncological patients (pts) should be offered anti covid-19 vaccine, due to the risk of severe infection and serious complications caused by Sars-CoV-2. Little is known about efficacy of covid-19 vaccine in oncological and onco-haematological pts, as they weren't enrolled in clinical trial. Recently evidence of lack of immune response in pts affected by LLC undergoing to mRNA vaccine has been reported. Methods: In our Oncological DH we administered anticovid- 19 mRNA vaccine (Comirnaty, Pfizer) to all pts on anticancer treatment, except to anti CD20 MoAb treated pts, according to guidelines. From 30/3 to 8/5/2021 we vaccinated 236 pts, for a total of 425 doses. Median interval between first and second dose was 21,25 days (range 21-28 days);pts with a diagnosis of Covid, 3-6 months before received a single vaccine dose. 196/236 (83%) pts were affected by solid cancer and 40/236 (17%) were affected by haematological malignancies. Most (34%), were treated with chemotherapy (CT), 23% were treated with a target therapy, TKI or CD4/6i (TT), 10% with immunotherapy (IT), 12% with hormonal therapy (OT) and 4% with immunosuppressors. SARS-CoV-2 Trimerics IgG test was performed in 195/236 pts, 164 with solid tumors, 31 with haematological malignancies. The median interval between the last vaccine dose and sierological test was 61 days (range 29-133 days). A cut-off > 33 BAU/ml was assumed for positive test. Results: None of the pts developed clinically meaningful adverse events after vaccination, but lymphadenopathy ipsilateral to the injection site was evident for at least one month after vaccination in CT and PET scan, complicating interpretation of restaging imaging. 184/195 (94%) pts had a sierological positive response to vaccine. Among them 68 were treated with CT, 54 with TT, 21 with IT and 12 with OT. 11 pts (11/195, 6%) were non-responders: 9 pts had haematological malignancy (9/31, 29%) and 2 had solid tumors (2/164, 1,2%). Among responders, CT treated patients showed SARS-CoV-2 IgG levels significantly lower than IT treated pts (p=0,014) and than TT treated pts (p=0,002), while no difference was evident between TT and IT pts. Conclusions: Most oncological pts on active treatment in our DH showed antibody response to anti SARS-Co-V2 vaccine;non-responders were mostly detected among haematological pts and CT treated pts;the latter showed also lower antibody production respect to TT and IT treated pts.
ABSTRACT
Purpose or Objective: In 2020 a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 spread all over the world, causing COVID-19 (COronaVIrus Disease-2019) pandemic. COVID-19 pandemic had an indirect impact to all the hospital services, as well as oncological activities. This impact, especially in the early months of 2020, represented an issue for Radiotherapy Departments, often finding medical staff unprepared to face COVID-19 pandemic. Aim of this study was to assess the indirect impact of COVID-19 to all the activities in our Radiation Oncology Department. Materials and Methods: From a large database, we retrospectively evaluated clinical activities trend from January 2020 to December 2020, comparing to 2019. Data related to clinical visits (first evaluations, follow-up), planning CT and PET/CT, treatment plannings, total number (n) of treated patients and of radiotherapy sessions on our 4 LINACs were examined. Results: In 2020, first clinical visits were 1890 vs 2022 in 2019 (-6.53%), planning CT and PET/CT in 2020 were 1680, similar to 2019 (n=1675) and in 2020 treatment plannings were 1608 (vs 1585 in 2019, +1.45%). Follow-up visits rapidly decreased in March and April 2020, as shown in Figure 1 (n=1324 in 2020 vs 1757 in 2019, -24.6%). During COVID-19 first (March, April 2020) and second (October, November 2020) peaks, follow-up visits were performed as tele-visits form in n=628. Total number of treatment sessions during 2020 was 21880 (24341 in 2019, -10.1% in 2020);hypofractioned regimens were preferred to reduce patients’ residence time for treatment in our Department (171 in 2020 vs 141 in 2019 for single-fraction palliative radiotherapy, with percent variations + 21.3%). Data of 2020 were reported in Figure 2. Eight patients, all asymptomatics, resulted occasionally positive to COVID-19;1 patient affected by glioblastoma and 7 by metastases (2 brain, 3 bone, 1 lung and 1 vagina). These latter were hospitalized waiting to palliative radiation treatment. During all the course of 2020, 21 patients refused to undergo radiotherapy;7 of these delayed first clinical evaluation. (Figure Presented) Conclusion: This analysis helped us to better understand the impact of COVID-19 in our Department and the consequences in radiotherapy activities, especially in the pandemic acute phase. Compared to 2019, radiotherapy activity dropped mainly in the first months of 2020. This reduction regarded mostly patients’ clinical visits, because of people fear of COVID-19 spread. Despite this decrease, radiation treatments never stopped even in the first peak of COVID-19 spread in Italy (March-April 2020). During all the 2020, the use of hypofractioned regimens rapidly increased for all the pathologies.