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Objectives: In breast cancer (BC) patients receiving mastectomy, postmastectomy radiotherapy (PMRT) improves long-term outcomes by decreasing local failure and cancer mortality. However, the optimal PMRT schedule is still under investigation. The present review aims to discuss the evidence regarding hypofractionated (HF) PMRT in BC patients in order to identify the optimal treatment approach. Additional purpose is to highlight what we have learned from COVID-19 era regarding HF schedules for PMRT in BC patients. Mechanism: Between February and November 2021, literature and database research were conducted. Key references were detected from a PubMed query. Range of publication date was between 2000 and 2021. Selection criteria included English language publications in humans. Hand searching included meeting proceedings of the European Society for Radiotherapy and Oncology (ESTRO), European Society of Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO) and American Society for Radiation Oncology (ASTRO). The website clinicaltrials.gov was also searched. Randomized controlled trials evaluating HF-PMRT were included. Findings in brief: Our research returned 87 published papers. Fourteen trials were included in our final analysis. The comparisons of several different schedules of HF-PMRT with conventional fractionated PMRT provided similar results in terms of locoregional disease control without increasing toxicity. Particularly, an acute skin toxicity incidence grade 2 or higher ranged between 10 and 25% among the studies we analyzed. Conclusion(s): The present paper suggests that safety and efficacy of HF-PMRT is comparable with conventional schedules and standard practice guidelines are already available. COVID-19 pandemic has emphasised the need for increasingly tailored treatment protocols. Modern HF regimens should continue to be the standard of treatment in BC patients who receive PMRT also in the post-COVID-19 era.Copyright © 2023 The Author(s).
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In the context of the novel Coronavirus pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the management of patients with cancer constitutes a real challenge. These patients are more likely to be immunocompromised due to the underlying malignancy or anticancer treatments. As a consequence, they are more at risk of contracting this virus and tend to show a higher rate of fatal cases. In order to reduce the risk of this pandemic among patients and health care professionals, oncologists are currently proposing hypofractionated radiotherapy regimens using higher doses per fraction, thus shortening treatment courses and saving treatment visits. Since higher doses of radiation may also increase the ACE/ACE2 activity, which has been identified as a key SARS-CoV-2 receptor, this paper raises the question of whether hypofractionated radiotherapy regimens further increase the infectivity of these already vulnerable patients.Copyright © 2021 Bentham Science Publishers.
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Background: During the SARS-CoV-2 virus pandemic, University Hospital Birmingham NHS Trust Oncology Department incorporated the ultrahypofractionated regime of 26Gy/5 fractions alongside the moderate hypofractionated regime of 40Gy/15 fractions as part of local adjuvant breast radiotherapy treatment (RT) for eligible patients. We conducted a local study to assess the real-life experience of patients undergoing ultrahypofractionated schedule to compare feasibility and toxicity to the fast-forward trial during the COVID - 19 pandemic. Methods: A single institution, retrospective, qualitative study. Patients included had early-stage breast cancer and received adjuvant radiotherapy between 23 March 2020 and 31 May 2020, a total of 211 patients. Inclusion was irrespective of any other neoadjuvant/adjuvant treatments. Data were collected retrospectively for treatment dose, boost dose and toxicity. Results: Of the total 211 patients, 85 were treated with 26Gy in 5# and 19 patients received a boost as per the fast-forward protocol. Of these 85 patients, 15.9% did not report any skin toxicity post-treatment. 63.5% of patients reported RTOG Grade 1, 15.9% had RTOG Grade 2, and 1.6% reported RTOG Grade 3 skin toxicity. 3.2% of the patients could not be contacted for follow-up. Of the 19 patients who received a breast boost, 10.53% reported no skin changes. 78.9% reported Grade 1 skin toxicity. Both Grades 2a and 2b skin toxicity were reported by 5.26% each. The patient demographics and tumour characteristics in our study cohort were comparable to those within the fast-forward trial. In terms of post-RT skin toxicity, fewer patients reported any toxicity in the UHB patient cohort versus those in the trial, and the number of Grade 2/3 toxicities reported was also low. A delay in toxicity reporting from 2 weeks for 40Gy/15 to 3 weeks for 26Gy/5 was observed. Conclusion: Our study concluded that offering ultrahypofractionation was convenient for patients;reducing the number of hospital visits during the SARS-CoV-2 virus pandemic appeared safe in terms of acute post-RT-related skin toxicity. The reduced hospital visits limited exposure of patients and staff to the SARS-CoV-2 virus while also ensuring efficient use of Radiotherapy Department resources. Local follow-up protocols have been amended to ensure review at 3 weeks for the 26Gy/5 schedule to acknowledge the delay in acute toxicity development. To date, there is only 5-year toxicity and relapse data available from the fast-forward trial;therefore, hypofractionation schedules should be offered to patients as long as they fulfil the criteria and understand the limitations of the study as well as accelerated peer review processes in the face of the pandemic. © 2022 The Author(s).
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Introduction Recently, the one-week hypofractionated radiotherapy regimen (26 Gy in 5 fractions) for adjuvant breast radiotherapy has been shown to be non-inferior to other hypofractionated regimens (15-16 fractions). The aim of the present dosimetric study is to compare Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (VMAT) and 3D Conformal Radiotherapy (3D-CRT) for a one-week hypofractionated radiotherapy regimen (26 Gy in 5 fractions) for adjuvant breast radiotherapy. Methods A total of 30 patients with histologically proven invasive carcinoma of the breast after breast conservation surgery (BCS) or modified radical mastectomy (MRM) were considered for in silico planning study. The dose prescription used was 26 Gy in 5 fractions as used in the FAST Forward protocol. Targets were contoured according to standard guidelines. The heart, ipsilateral lung, and contralateral breast were contoured as organs at risk. Results Planning Target Volume (PTV) coverage: For IMRT, VMAT and 3D-CRT, respectively, the volumes that received at least 95% of the prescription dose (V95) were 95.7 ± 2.12, 92.47 ± 3.83, 90.87 ± 5.13; mean PTV doses (Dmean) were 26.1 ± 0.6, 25.7 ± 0.7, and 28 ± 4.39 (3D-CRT has higher Dmean compared to other techniques). Maximum PTV doses (Dmax) were 28.23 ± 0.72, 28.73 ± 0.64, and 29.8 ± 1.03. IMRT had a better V95 coverage and conformity index. Organs At Risk (OARs): The volumes that received at least 25% of the prescription dose (V25) of the heart were 3.41 ± 4.7, 1.8 ± 2.02 and 4.3 ± 6.98 in IMRT, VMAT and 3D-CRT, respectively. The volumetric (V25) comparison of heart dose in left-sided breast cancer was significantly different between VMAT and 3D-CRT (p=0.04, Wilcoxon signed-rank test). The volume that received at least 5% of the prescription dose (V5 ) was less than 25% in the 3D-CRT plan (12.55). For the ipsilateral lung, the V25 parameters were 19.53 ± 10.96, 23.93 ± 13.58 and 20.5 ± 12.32 in IMRT, VMAT and 3D-CRT, respectively. Conclusion From this study, we can conclude that IMRT and VMAT techniques are feasible and can achieve better dosimetric goals for target and OARs though minimizing the area achieving low dose remains to be a dosimetric concern for VMAT.
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Hypofractionation has shown to be beneficial in the management of a wide range of cancers1,2 including other advantages such as cost savings3. Trials over the last decade4,5,6 have demonstrated the advantages of hypofractionation compared with a standard radiotherapy regimen3. Covid-19 significantly impacted the way in which cancer patients7 are managed and even though the use of hypofractionation is well established in some cancer types;the application thereof during the pandemic has been widely expanded to minimise treatment time8. Even though the treatment outcomes have been well defined, there is limited evidence to suggest changes in patient care. Some oncology centres advocated for a reduced contact time between patient and staff9. Hypofractionation in an ageing population is particularly advantageous in allowing people to receive treatment in a shorter time demonstrating treatment outcomes similar to younger age groups10 however;greater consideration should be given to performance status and comorbidities associated with these treatment outcomes11. Fractionation schedules which allow delivery in less fractions, can be highly effective with limited treatment-related toxicity. Studies have shown that the late consequences of radiotherapy in these patient groups are seldom an issue even with larger fraction s12. However more recent studies suggest that a reduction in treatment time should not be the only reason for selecting this approach. Moderate hypofractionation should therefore be considered for those patient who are younger and who might experience long terms effects13. More studies are now investigating the tolerability of ultra-hypofractionated radiotherapy in an attempt to improve the therapeutic gain, suggesting that these approaches are well-tolerated and showed no statistical difference in toxicity14. Hypofractionation in radiotherapy may be a good alternative to conventional fractionation however patience care remains paramount in the management of all toxicities related the radiotherapy delivery. There is no evidence to suggest the patient care of these patients have changed, however the tolerability and outcomes of this method of delivery requires constant review. Patient care needs to consider the site of treatment, age of the patient, performance status, and tolerability. A model of shared decision making in managing care is advocated with greater emphasis on selfcare.
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Purpose or Objective We designed a hypofractionated radiotherapy protocol for adjuvant or salvage treatment after radical prostatectomy. In this first report we present the implementation of this protocol in the context of a COVID-19 pandemic. Materials and Methods Patients meeting the inclusion criteria (high-risk features on histopathology or biochemical recurrence) received radiotherapy to the prostate bed 51 Gy in 17 fractions, elective treatment of the pelvis at a dose of 36 Gy in 12 fractions was permited. Acute gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events versión 4.03. The disease-related quality of life, urinary, gastrointestinal, sexual and hormonal function were evaluated with the Expanded Prostate Cancer Index Composite (EPIC), QLQc30 and PR25 questionnaires at baseline before the start of radiotherapy and at one month after radiotherapy, then every six monts for two years. In addition, the incidence of COVID-19 cases was reported in the patients recruited in the trial and in those who underwent standard fractionation treatment (1.8-2.0 Gy per fraction), and in health personnel involved in the treatment of patients in study period. Results From August 2020 to March 2021, 22 patients have been registered. Fourteen patients have completed treatment and are included in this report. The median age was 64 years and most had a Gleason 3 + 4 (50%), with a pT3a (35.7%) and negative surgical margins (71.4%). Three patients (21.4%) were staged as pN1. Most patients were treated for salvage (57.1%), with an median PSA prior to the start of RT of 0,29 ng/ml. Most patients report minimal or low acute radiation effects in terms of GI and GU toxicity, with an acute toxicity grade 2 GI and GU of 50% and 14.3%, respectively. Without Grade 3 or higher GI / GU toxicity. Of the 14 patients who received the trial protocol, none had a clinical of COVID-19 infection, while one patient who received treatment with conventional fractionation development a COVID-19 infection. Conclusion We present the implementation of an protocol of hypofractionated schedule of postoperative prostate radiotherapy in an academic center in a developing country in the context of a COVID-19 pandemic. Preliminary results show the absence of COVID infection in the included patients, and low GU and GI toxicity.
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Background and Objectives: Reducing time of treatment during COVID-19 outbreaks has been recommended by the leading Radiation Oncology societies. Still minimizing radiation induced tissue toxicity is one of the most important issues in breast cancer patients. The study aimed to investigate compliance, clinical and dosimetry normal tissue toxicity, and cosmetic results between moderated and ultra-fractionated regimes for breast cancer patients during COVID-19 pandemic. Materials and Methods: This pilot prospective randomized study included 60 patients with early breast cancer after preserving surgery, 27 patients advocated to ultra-hypofractionated whole-breast three dimensional (3D) conformal radiotherapy of 26 Gy in 5 fractions over 1 week and 33 patients with moderate fractionated breast 3D conformal radiotherapy patients between March 2020 and July 2020, during the COVID pandemic outbreak. The compliance to treatment, dosimetric parameters, acute and late skin toxicity, subcutaneous tissue toxicity, cosmetic results and clinical follow up for 18 months for the two regimes were analyzed and compared. Results: When two regimes were compared 5 fraction group had significantly lower prevalence of newly infected cases of SARS-CoV-2 and thus delayed/interrupted treatment (p = 0.05), comparable grade 1 CTCAE v5, acute skin toxicity (p = 0.18), Grade 1 Radiation Morbidity Scoring Scheme (RESS) subcutaneous tissue toxicity (p = 0.18), Grade 1 RESS late skin toxicity (p = 0.88) and cosmetic results (p = 0.46). Dosimetric results reveled that patients in 5 fraction group received significantly lower median ipsilateral lung doses (p < 0.01) in addition to left breast cancer patients that received significantly lower median heart dose (p < 0.01) and median left anterior descending artery (LAD) dose (p < 0.01). Conclusion: Ultra-hypofractionated radiotherapy for breast cancer is comparable to moderate hypofractionation regimen regarding grade 1 acute skin toxicity, grade 1 subcutaneous tissue toxicity, late skin toxicity and cosmetic results. Application of ultra-hypofractionated radiotherapy with significantly lower radiation doses for lung and heart could be crucial in reducing the risk of acute/late pulmonary and heart radiation-induced toxicity.
Subject(s)
Breast Neoplasms , COVID-19 , Radiation Injuries , Radiotherapy, Conformal , Breast Neoplasms/epidemiology , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Humans , Pandemics , Prospective Studies , Radiotherapy, Conformal/adverse effects , Radiotherapy, Conformal/methods , SARS-CoV-2ABSTRACT
AIMS: Adjuvant radiotherapy is recommended for most patients with early breast cancer (EBC) receiving breast-conserving surgery and those at moderate/high risk of recurrence treated by mastectomy. During the first wave of COVID-19 in England and Wales, there was rapid dissemination of randomised controlled trial-based evidence showing non-inferiority for five-fraction ultra-hypofractionated radiotherapy (HFRT) regimens compared with standard moderate-HFRT, with guidance recommending the use of five-fraction HFRT for eligible patients. We evaluated the uptake of this recommendation in clinical practice as part of the National Audit of Breast Cancer in Older Patients (NABCOP). MATERIALS AND METHODS: Women aged ≥50 years who underwent surgery for EBC from January 2019 to July 2020 were identified from the Rapid Cancer Registration Dataset for England and from Wales Cancer Network data. Radiotherapy details were from linked national Radiotherapy Datasets. Multivariate mixed-effects logistic regression models were used to assess characteristics influential in the use of ultra-HFRT. RESULTS: Among 35 561 women having surgery for EBC, 71% received postoperative radiotherapy. Receipt of 26 Gy in five fractions (26Gy5F) increased from <1% in February 2020 to 70% in April 2020. Regional variation in the use of 26Gy5F during April to July 2020 was similar by age, ranging from 49 to 87% among women aged ≥70 years. Use of 26Gy5F was characterised by no known nodal involvement, no comorbidities and initial breast-conserving surgery. Of those patients receiving radiotherapy to the breast/chest wall, 85% had 26Gy5F; 23% had 26Gy5F if radiotherapy included regional nodes. Among 5139 women receiving postoperative radiotherapy from April to July 2020, nodal involvement, overall stage, type of surgery, time from diagnosis to start of radiotherapy were independently associated with fractionation choice. CONCLUSIONS: There was a striking increase in the use of 26Gy5F dose fractionation regimens for EBC, among women aged ≥50 years, within a month of guidance published at the start of the COVID-19 pandemic in England and Wales.
Subject(s)
Breast Neoplasms , COVID-19 , Aged , Breast Neoplasms/epidemiology , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , COVID-19/epidemiology , Cohort Studies , Female , Humans , Mastectomy , Mastectomy, Segmental , Pandemics , Radiotherapy, Adjuvant/adverse effects , Wales/epidemiologyABSTRACT
Introduction: Hypofractionated radiotherapy (HF-RT) has been used in the UK as a non-surgical treatment for locally advanced laryngeal cancer (LALC) in the past. HF-RT has been readopted in some departments during the COVID-19 pandemic due to having a shorter overall treatment time and fewer attendances. This study explores the outcomes of a cohort of patients treated from 2003 to 2012 at Aberdeen Royal Infirmary (Scotland, UK). Materials and Methods: 36 patients received HF-RT (55 Gy in 20 fractions) through 2D or 3D conformal radiotherapy, 7 of them received concurrent cisplatin (CRT). Overall survival (OS), locoregional recurrence free survival (LRFS), progression free survival (PFS), laryngectomy free survival (LFS), disease specific survival (DSS) and late toxicity data were analysed in patients treated with HF-RT at 1-year (1Y), 2-year (2Y) and 5-year (5Y). The same outcomes were measured between the RT and CRT group for any differences. Results: The mean follow-up durationwas 43.0 months. OS at 1Y, 2Y and 5Y was 69.4%, 52.8% and 30.6%. LRFS at 1Y, 2Y and 5Y was 63.9%, 47.2% and 25.0%. PFS at 1Y, 2Y and 5Y was 63.9%, 44.4% and 25.0%. LFS at 1Y, 2Y and 5Y was 69.4%, 50.0% and 27.8%. DSS at 1Y, 2Y and 5Y was 63.9%, 52.8% and 30.6%. During the period of treatment and up to 5Y follow up, 41.7% of patients required an NG tube for feeding and 25% required a PEG tube at any point. 22.2% of patients required long term enteral feeding via PEG tube beyond 5Y. No significant differences were found in the survival outcomes or alternative feeding route outcomes between patients treated by RT alone or CRT. Conclusions: HF-RT constitutes an alternative for the treatment of LALC with acceptable local control and toxicity. Further investigation is needed in the comparison of this regime with standard fractionation and its application with modern radiotherapy techniques
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Background: During the COVID19 pandemic, many centres in the UK, shifted towards utilising hypofractionated radiotherapy (RT) to pancreas. We aim to report the UK experience hypofractionated (3-5 fractions) RT to the pancreas from 7 centres in the UK. Rates of toxicity, progression, death and potential prognostic factors were assessed. Univariate and multivariate Cox proportional hazards analyses were performed. Results: 92 patients from 7 centres were included in the analysis (median age 71 (range 49-88). 90% had performance status of 0-1. 66% had locally advanced disease. 53% had RT delivered over 3- 5 fractions (n = 49, median: 30Gy/5f, range:30- 40Gy in 3-5f). The rest had 15-fraction RT with or without concurrent chemotherapy (n = 43, median: 45Gy/15f, range: 36-45Gy/15f). Induction chemotherapy (CT) was used in 64% (FOLFIRINIOX -42/59). Median follow-up was 13 months from first treatment (induction CT or RT). Median overall survival (OS) among all patient was 17 months, (95% CI-14.5-19.5 months). On multivariable analysis, induction CT was the only predictor of improved PFS (median survival (MS) 12 vs 5 months;hazard ratio [HR] 0.23;95% confidence interval [CI]: 0.12-0.44, p < 0.001) and OS (MS 24 vs 11 months;HR 0.15;95% CI: 0.07 - 0.34, p < 0.001). There were no deaths. 4 patients had grade 3+ toxicities (transaminitis, cholecystitis and gall bladder perforation, small bowel obstruction and diarrhoea) -all had concurrent CT. Conclusions: Our survival outcome appears to be comparable with published data from CT + concurrent chemoradiotherapy. Induction CT appears to improve outcome. Careful selection of patients can help maximise advantage in this patient population.
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BACKGROUND: Prostate stereotactic body radiotherapy (SBRT), which delivers high-dose precision treatment in ≤5 fractions, is a shorter, more convenient, and less expensive alternative to conventionally fractionated radiotherapy (CRFT; â¼44 fractions) or moderately hypofractionated radiotherapy (MFRT; 20-28 fractions). SBRT has not been widely adopted but may have radiobiologic advantages over CFRT/MFRT. We hypothesized that SBRT would be associated with improved overall survival (OS) versus CFRT or MFRT ± androgen deprivation therapy (ADT) for unfavorable-intermediate-risk prostate cancer (UIR-PCa). METHODS: Men with UIR-PCa treated with SBRT (35-40Gy in ≤5 fractions) or biologically equivalent doses of CFRT (72-86.4Gy in 1.8-2.0Gy/fraction) or MRFT (≥60Gy in 2.4-3.2Gy/fraction; biologically effective doses ≥120) were identified in the National Cancer Database (NCDB). Unweighted and propensity-weighted multivariable Cox analysis (MVA) was used to compare OS hazard ratios. RESULTS: Of 28,028 men with UIR-PCa who received CFRT with (n = 12,872) or without ADT (n = 12,984); MFRT with (n = 251) or without ADT (n = 281); and SBRT with (n = 212) or without ADT (n = 1,428) were identified. Relative to CFRT without ADT, CFRT+ ADT (HR 0.92, 95% CI 0.87-0.97, P = .002) and SBRT without ADT (HR 0.74, 95% CI 0.61-0.89, P = .002) were both associated with improved OS on MVA. Relative to CFRT+ADT, SBRT without ADT correlated with improved OS on MVA (HR:0.81, 95% CI 0.67-0.99, P = .04). Propensity-weighted MVA demonstrated that SBRT (HR:0.80, 95% CI 0.65-0.98, P = .036) and ADT (HR:0.91, 95% CI 0.86-0.97, P = .002) correlated with improved OS. SBRT was not associated with improved OS versus MFRT. CONCLUSION: SBRT, which offers a cheaper and shorter treatment course that mitigates COVID-19 exposure, was associated with improved OS versus CFRT for UIR-PCa. These results confirm guideline-based recommendations that SBRT is a viable option for UIR prostate cancer. The results from this large retrospective study require further validation in clinical trials.
Subject(s)
COVID-19 , Prostatic Neoplasms , Radiosurgery , Androgen Antagonists/therapeutic use , Humans , Male , Prostatic Neoplasms/drug therapy , Radiosurgery/methods , Retrospective Studies , Survival AnalysisABSTRACT
The current pandemic due to the new coronavirus (SARS-CoV-2) has put health systems around the world to the test, in a way so urgent that had not been seen in several years. The implications in health care not only affect patients with COVID-19, but they are transversal to all pathologies. Specifically in breast cancer, hypofractionated radiotherapy schemes constitute a valid and safe alternative that helps reduce the exposure of patients to the new virus, the congestion of health institutions and the costs of specialized cancer treatments. In this article, we conducted a review of the most relevant literature on shortened radiotherapy regimens in breast cancer: hypofractionation and extreme hypofractionation, and their equivalence with fractionation. In the end, the recommendations of different scientific societies and international experts are highlighted, to consider hypofractionated radiotherapy schemes, regarding the global health contingency. © 2021
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Purpose or Objective To evaluate the influence of Charlson comorbidity index (CCI) in survival outcomes in patients (pts) with lung cancer (LC) treated with concomitant radiochemotherapy (RCT) or radiotherapy (RT) alone with radical intention during SARS-2-COVID19 pandemic. Materials and Methods Retrospective study of 50 pts with LC treated with radical intention from November 2019 to December 2020 in University Hospital of Badajoz and University Hospital Virgen Macarena in Seville. All pts were treated with radical intention and hypofractionated scheme of radiotherapy (total dose 55 Gy in 20 fractions of 2.75 Gy/daily) to decrease the duration of thoracic radiotherapy in pandemic era. 40% of pts were treated with concomitant RCT, 38% with RT alone and 22% with chemotherapy and sequential RT. CCI was used to identify associated diseases in all pts, after the evaluation of 19 items that influence in the life expectancy of them. In general, it is considered low comorbidity ≤ 3 points in CCI and high comorbidity > 3 points. Kaplan-Meier curves have been used for the statistical analysis of overall survival (OS) and cancer specific survival (CSS) and log-rank test to compare them. Results In the study, 24 pts had ≤ 3 points in CCI (48%) and 26 pts had > 3 points (52%). Mean CCS in pts with CCI≤ 3 points was 18.5 months and in pts with CCI > 3 points was 13 months. 15-months CSS was 83.3% in pts with CCI ≤ 3 points and 40.9% in pts with CCI > 3 points without statistically significant differences (p 0.755). Mean OS in pts with CCI≤ 3 points was 16.8 months and in pts with CCI > 3 points was 11.5 months.15-months OS was 74.3% in pts with CCI ≤ 3 points and 32% in pts with CCI > 3 points (p 0.620). Toxicity in both groups was similar without differences between pts with CCI ≤ 3 points and CCI > 3 points. Only one grade 3 oesophagitis was registered in CCI ≤ 3 points group. Conclusion The Charlson comorbidity index is a system that evaluates 10 years life expectancy. According to our results and despite the short follow-up, pts with CCI ≤ 3 points have better OS and CSS than pts with CCI > 3 points. In both groups, hypofractionated radiotherapy was well-tolerated regardless the CCI. Although more studies are needed, CCI can be an important factor to evaluate in patients with lung cancer because it identifies pts with a high probability of mortality. For this reason, this score can be an useful tool to assess the most suitable treatment option, especially in patients with several comorbidities.
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As a result of the coronavirus disease 2019 (COVID-19) pandemic, radiation therapies have been modulated to reduce the risk of infection during outpatient activities and hypofractionated regimens or radiotherapy delay for nonmelanoma skin cancer (NMSC) were suggested. Hypofractionated radiotherapy not only may confer no disadvantage in regard to outcome when compared to a more protracted schedule but might also reduce the risk of infection. We report the experience of a dermatologic radiation therapy department concerning a group of patients with a diagnosis of NMSC selected for a radiation treatment plan aimed to minimize the number of their accesses to our department.