ABSTRACT
PURPOSE: The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS: A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS: Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24â¯h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION: RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.
Subject(s)
COVID-19/epidemiology , Lymphoma/radiotherapy , Multiple Myeloma/radiotherapy , Pandemics , Radiation Oncology/standards , SARS-CoV-2/isolation & purification , Triage/standards , Appointments and Schedules , COVID-19/complications , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Testing , Cross Infection/prevention & control , Diagnosis, Differential , Dose Fractionation, Radiation , Humans , Hygiene/standards , Infection Control/methods , Infection Control/standards , Lymphoma/complications , Lymphoma/drug therapy , Multiple Myeloma/complications , Osteolysis/etiology , Osteolysis/radiotherapy , Personal Protective Equipment , Radiation Oncology/methods , Radiation Pneumonitis/diagnosis , Superior Vena Cava Syndrome/etiology , Superior Vena Cava Syndrome/radiotherapy , Surveys and Questionnaires , Time-to-Treatment , Whole-Body IrradiationSubject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hematologic Neoplasms/radiotherapy , Pneumonia, Viral/epidemiology , Radiation Oncology/standards , COVID-19 , Hodgkin Disease/radiotherapy , Humans , Lymphoma/radiotherapy , Organs at Risk/radiation effects , Pandemics , Radiation Dose Hypofractionation , SARS-CoV-2ABSTRACT
The International Lymphoma Radiation Oncology Group (ILROG) guidelines for using radiation therapy (RT) in hematological malignancies are widely used in many countries. The emergency situation created by the COVID-19 pandemic may result in limitations of treatment resources. Furthermore, in recognition of the need to also reduce the exposure of patients and staff to potential infection with COVID-19, the ILROG task force has made recommendations for alternative radiation treatment schemes. The emphasis is on maintaining clinical efficacy and safety by increasing the dose per fraction while reducing the number of daily treatments. The guidance is informed by adhering to acceptable radiobiological parameters and clinical tolerability. The options for delaying or omitting RT in some hematological categories are also discussed.