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1.
Medicina (Kaunas) ; 58(6)2022 May 30.
Article in English | MEDLINE | ID: covidwho-1869708

ABSTRACT

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-2
2.
J Appl Clin Med Phys ; 23(3): e13506, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1733832

ABSTRACT

PURPOSE: To evaluate a knowledge-based (KB) planning model for RapidPlan, generated using a five-field intensity-modulated radiotherapy (IMRT) class solution beam strategy and rigorous dosimetric constraints for accelerated partial breast irradiation (APBI). MATERIALS AND METHODS: The RapidPlan model was configured using 64 APBI treatment plans and validated for 120 APBI patients who were not included in the training dataset. KB plan dosimetry was compared to clinical plan dosimetry, the clinical planning constraints, and the constraints used in phase III APBI trials. Dosimetric differences between clinical and KB plans were evaluated using paired two-tailed Wilcoxon signed-rank tests. RESULTS: KB planning was able to produce IMRT-based APBI plans in a single optimization without manual intervention that are comparable or better than the conventionally optimized, clinical plans. Comparing KB plans to clinical plans, differences in PTV, heart, contralateral breast, and ipsilateral lung dose-volume metrics were not clinically significant. The ipsilateral breast volume receiving at least 50% of the prescription dose was statistically and clinically significantly lower in the KB plans. CONCLUSION: KB planning for IMRT-based APBI provides equivalent or better dosimetry compared to conventional inverse planning. This model may be reliably applied in clinical practice and could be used to transfer planning expertise to ensure consistency in APBI plan quality.


Subject(s)
Breast Neoplasms , Radiotherapy, Intensity-Modulated , Breast/radiation effects , Breast Neoplasms/radiotherapy , Female , Humans , Knowledge Bases , Radiometry , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted
3.
Cancer Radiother ; 26(4): 577-584, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1664711

ABSTRACT

PURPOSE: The coronavirus disease 2019 (covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early and late toxicity in patients infected with covid-19 treated at the same time for early-stage breast cancer. MATERIAL AND METHODS: This is a monocentric prospective study of patients treated in our hospital between March and June 2020 who were diagnosed with covid-19 infection. The inclusion criteria were to be irradiated for early-stage breast cancer and to have a positive covid diagnosis on a polymerase chain reaction (PCR) test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. All of them needed 6 months follow-up clinic after the end of the radiotherapy with clinical examination, mammogram, as well as CT scan to evaluate the lung status. Radiotherapy consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the Common Toxicology Criteria for Adverse Events (version 4.03). RESULTS: All 350 patients treated for early-stage breast cancer were studied. Of them, 16 presented clinical symptoms of covid-19 infection, and of them 12 had clinical, CT scan and PCR confirmation. This entire cohort of 12 patients with median age of 56years (range: 42-72 years) underwent their radiotherapy. During the radiotherapy, nine patients presented radiodermatitis: eight grade 1 (66%) and one grade 2 (8%). Two patients with lymph nodes irradiation presented grade 2 oesophagitis. Late toxicity was evaluated 6 months after the end of the radiotherapy, and there was no radiation or covid lung sequel on the CT scans. One patient presented covid-related dyspnoea, and two had fibrosis. CONCLUSION: The half-year follow-up of prospective covid-19 cohort, treated for early-stage breast cancer demonstrated an acceptable toxicity profile with few low-grade adverse events. It seems that the covid-19 infection does not appear to increase the side effects of radiotherapy. Therefore radiotherapy should not be delayed.


Subject(s)
Breast Neoplasms , COVID-19 , Radiodermatitis , Adult , Aged , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Female , Humans , Middle Aged , Prospective Studies , Radiodermatitis/etiology , SARS-CoV-2
4.
Semin Radiat Oncol ; 32(2): 155-158, 2022 04.
Article in English | MEDLINE | ID: covidwho-1586521

ABSTRACT

Breast cancer in older patients presents an increasing health care challenge. Hypofractionated dose schedules of 15/16 daily fractions of postoperative radiotherapy over 3/3.5 weeks have been established in clinical trials with long term follow up as safe and effective and become the standard of care after breast conserving therapy for most older patients. Emerging clinical trial data are pushing the limits of hypofractionation to even shorter schedules over a week. In this mini-review the applicability of this new data to older patients is discussed and the development of guidelines for hypofractionated dose fractionation schedules adapted to the COVID19 pandemic for this age group.


Subject(s)
Breast Neoplasms , COVID-19 , Aged , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Dose Fractionation, Radiation , Female , Humans , Mastectomy, Segmental , Radiation Dose Hypofractionation , Radiotherapy, Adjuvant
5.
Lancet Oncol ; 23(1): e21-e31, 2022 01.
Article in English | MEDLINE | ID: covidwho-1586210

ABSTRACT

High-quality randomised clinical trials testing moderately fractionated breast radiotherapy have clearly shown that local control and survival is at least as effective as with 2 Gy daily fractions with similar or reduced normal tissue toxicity. Fewer treatment visits are welcomed by patients and their families, and reduced fractions produce substantial savings for health-care systems. Implementation of hypofractionation, however, has moved at a slow pace. The oncology community have now reached an inflection point created by new evidence from the FAST-Forward five-fraction randomised trial and catalysed by the need for the global radiation oncology community to unite during the COVID-19 pandemic and rapidly rethink hypofractionation implementation. The aim of this paper is to support equity of access for all patients to receive evidence-based breast external beam radiotherapy and to facilitate the translation of new evidence into routine daily practice. The results from this European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus state that moderately hypofractionated radiotherapy can be offered to any patient for whole breast, chest wall (with or without reconstruction), and nodal volumes. Ultrafractionation (five fractions) can also be offered for non-nodal breast or chest wall (without reconstruction) radiotherapy either as standard of care or within a randomised trial or prospective cohort. The consensus is timely; not only is it a pragmatic framework for radiation oncologists, but it provides a measured proposal for the path forward to influence policy makers and empower patients to ensure equity of access to evidence-based radiotherapy.


Subject(s)
Advisory Committees/standards , Breast Neoplasms/radiotherapy , Dose Fractionation, Radiation , Patient Selection , Radiation Oncology/standards , Breast Neoplasms/pathology , COVID-19/epidemiology , Consensus , Europe , Evidence-Based Medicine , Female , Humans , Radiation Dose Hypofractionation
6.
Med Oncol ; 39(1): 5, 2021 Nov 05.
Article in English | MEDLINE | ID: covidwho-1504271

ABSTRACT

The purpose of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on patients undergoing radiotherapy by comparing the patterns of unplanned radiotherapy interruption before and after the COVID-19 pandemic. We enrolled patients who received their first dose of radiotherapy for breast cancer between January 28 and July 31, 2019 and between January 28, 2020, and July 31, 2020. We compared the radiotherapy interruption patterns in 2019 with those in 2020 to analyze the impact of the COVID-19 pandemic on treatment interruption. Between January 28 and July 31, 2019, 287 patients with breast cancer received radiotherapy. Among them, 19 patients (6.6%) experienced treatment interruption; the reasons for treatment interruption were radiotherapy-related side effects (10 patients, 52.6%), other medical reasons (three patients, 15.8%), and personal reasons (six patients, 31.6%). Between January 28 and July 31, 2020, 279 patients with breast cancer received radiotherapy. Among them, 23 patients (8.2%) experienced treatment interruption; the reasons for treatment interruption were radiotherapy-related side effects (eight patients, 35%) and COVID-19 screening clinic-related reasons (six patients, 26.1%). Among the six patients with screening clinic-related causes of radiotherapy interruption, five had asymptomatic fever and one had mild cold-like symptoms. The duration of treatment interruption was longer in patients with screening clinic-related interruptions than in those with interruptions because of other causes (p = 0.019). Multivariate analysis showed that cancer stage and radiotherapy volume did not significantly affect treatment interruption. The radiotherapy of certain patients was suspended despite the lack of a confirmed COVID-19 diagnosis. Precise and systematic criteria for the management of patients with suspected COVID-19 are needed, and the opinion of radiation oncologist in charge of the patient must also be considered.


Subject(s)
Breast Neoplasms , COVID-19 , Continuity of Patient Care/statistics & numerical data , Mass Screening/statistics & numerical data , Pandemics , Adult , Breast Neoplasms/epidemiology , Breast Neoplasms/radiotherapy , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Middle Aged , Practice Guidelines as Topic
7.
In Vivo ; 35(5): 2763-2770, 2021.
Article in English | MEDLINE | ID: covidwho-1441422

ABSTRACT

BACKGROUND/AIM: Being scheduled for radiotherapy can cause emotional distress. This study aimed to identify risk factors in 338 patients assigned to radiotherapy for breast cancer. PATIENTS AND METHODS: Nineteen potential risk factors including the COVID-19 pandemic were investigated for associations with the six emotional problems included in the National Comprehensive Cancer Network Distress Thermometer. RESULTS: Worry and fears were significantly associated with age ≤60 years; sadness with age and Karnofsky performance score (KPS) <90; depression with KPS and Charlson Comorbidity Index ≥3; loss of interest with KPS. Trends were found for associations between sadness and additional breast cancer/DCIS, Charlson Index and chemotherapy; between depression and additional breast cancer/DCIS, treatment volume and nodal stage N1-3; between nervousness and additional breast cancer/DCIS, mastectomy and triple-negativity; between loss of interest and Charlson Index, family history of breast cancer/DCIS, invasive cancer, chemotherapy, and treatment volume. The COVID-19 pandemic did not increase emotional problems. CONCLUSION: Several risk factors for emotional problems were identified. Patients with such factors should receive psychological support well before radiotherapy.


Subject(s)
Breast Neoplasms , COVID-19 , Carcinoma, Intraductal, Noninfiltrating , Breast Neoplasms/epidemiology , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Carcinoma, Intraductal, Noninfiltrating/surgery , Female , Humans , Mastectomy , Mastectomy, Segmental , Middle Aged , Pandemics , Radiotherapy, Adjuvant/adverse effects , SARS-CoV-2
8.
Breast J ; 27(11): 824-827, 2021 11.
Article in English | MEDLINE | ID: covidwho-1373920

ABSTRACT

The COVID-19 caused by the SARS-CoV-2 coronavirus is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early toxicity in patients infected with COVID-19 treated at the same time for early-stage breast cancer (BC). This is a monocentric prospective study of patients treated in our hospital between March 2020 and June 2020 and were diagnosed with COVID-19 infection. The inclusion criteria were to be irradiated for early-stage BC and to have a positive COVID-19 diagnosis on a PCR test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. Radiotherapy (RT) consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the CTCAE (version 4.03). All 350 patients treated for early-stage BC were studied. Of them, 16 were presented with clinical symptoms of COVID-19 infection and of them, 12 had clinical, CT scan, and PCR confirmation. This entire cohort of 12 pts with median age of 56 (42-72) underwent their RT. During the radiotherapy, there were 9 pts presented radiation dermatitis, 8 (66%) were grade 1 and one was (8%) grade 2. Two patients with lymph nodes irradiation presented esophagitis grade 2. This prospective COVID-19 cohort, treated for early-stage BC demonstrated an acceptable toxicity profile with few low-grade adverse events. Longer follow-up is needed to confirm these findings.


Subject(s)
Breast Neoplasms , COVID-19 , Breast Neoplasms/radiotherapy , COVID-19 Testing , Female , Humans , Prospective Studies , SARS-CoV-2
9.
Clin Imaging ; 80: 19-25, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1293658

ABSTRACT

Partial breast irradiation (PBI) and ultra-hypofractionated whole breast irradiation (uWBI) are contemporary alternatives to conventional and standard hypofractionated whole breast irradiation (WBI), which shorten treatment from 3 to 6 weeks to 1-2 weeks for select patients. PBI and accelerated PBI (APBI) can be delivered with external beam radiation (3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT)), intraoperative radiation (IORT), or brachytherapy. These new radiation techniques offer the advantage of convenience and lower cost, which ultimately improves access to care. Globally, the COVID 19 pandemic has accelerated APBI/PBI and ultra-hypofractionated regimens into routine practice for carefully selected patients. Recent long-term data from randomized controlled trials (RCTs) have demonstrated these techniques are safe and effective in suitable patients demonstrating equivalent or improved local recurrence, acute/late toxicity, and cosmesis. PBI and APBI should be limited to low risk unifocal invasive ductal carcinoma and ductal carcinoma in situ with tumor size < 2 cm, clear margins (≥2 mm), ER+, and negative nodes. Based on the results from UK Fast-Forward and UK FAST ultra-hypofractionated breast radiation can be safely employed for early stage node negative patients, but is not yet considered an international standard of care. In this review, authors will appraise recent data for these shorter course radiation treatment regimens, as well as, considerations for breast radiologists including surveillance imaging and radiographic findings.


Subject(s)
Breast Neoplasms , COVID-19 , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Humans , Mastectomy, Segmental , Neoplasm Recurrence, Local , Radiologists , SARS-CoV-2
10.
In Vivo ; 35(4): 2253-2260, 2021.
Article in English | MEDLINE | ID: covidwho-1285628

ABSTRACT

BACKGROUND/AIM: The anticipation of radiotherapy can cause distress and sleep disorders, which may be aggravated by the COVID-19 pandemic. This study investigated sleep disorders in a large cohort of patients with breast cancer before and during the pandemic. PATIENTS AND METHODS: Twenty-three characteristics were retrospectively analyzed for associations with pre-radiotherapy sleep disorders in 338 patients. Moreover, 163 patients presenting before and 175 patients presenting during the COVID-19 pandemic were compared for sleep disorders. RESULTS: Sleep disorders were significantly associated with age ≤60 years (p=0.006); high distress score (p<0.0001); more emotional (p<0.0001), physical (p<0.0001) or practical (p<0.0001) problems; psycho-oncological need (p<0.0001); invasive cancer (p=0.003); chemotherapy (p<0.001); and hormonal therapy (p=0.006). Sleep disorders were similarly common in both groups (prior to vs. during the pandemic: 40% vs. 45%, p=0.38). CONCLUSION: Although additional significant risk factors for sleep disorders were identified, the COVID-19 pandemic appeared to have no significant impact on sleep disorders in patients scheduled for irradiation of breast cancer.


Subject(s)
Breast Neoplasms , COVID-19 , Sleep Wake Disorders , Breast Neoplasms/complications , Breast Neoplasms/epidemiology , Breast Neoplasms/radiotherapy , Female , Humans , Middle Aged , Pandemics , Radiotherapy, Adjuvant/adverse effects , Retrospective Studies , SARS-CoV-2 , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/etiology
11.
J Geriatr Oncol ; 12(7): 1130-1135, 2021 09.
Article in English | MEDLINE | ID: covidwho-1233491

ABSTRACT

This review is aimed at evaluating whether radiation therapy (RT) can be omitted in older adult early-stage low-risk breast cancer (BC) patients. The published data are particularly relevant at present, during the COVID-19 pandemic emergency, to define a treatment strategy and to prioritize essential therapy. Cochrane Database of Systematic Reviews and PubMED were systematically researched from outset through April 2020 using Mesh terms. Only randomized controlled trials (RCT), with one arm without adjuvant whole-breast irradiation (WBI), were included in the analysis. Recent literature regarding the COVID pandemic and BC RT was assessed. The reported RCTs identified a group of BC patients (pT1-2N0M0 R0, grade 1-2, estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative tumours) in which the absolute risk of local recurrence (LR) was considered low enough to omit RT. The most common risk factors were tumor diameter, nodal and receptor status. Adjuvant RT had a significant impact on LR but not on distant metastasis (DM) or death. During the COVID 19 pandemic, results from RTCs were re-considered to define treatment recommendations for BC patients. International scientific societies and radiation oncology experts suggested RT omission, whenever possible, in older adult early-stage BC patients. Adjuvant RT might be omitted in a highly selected group of older adult early-stage BC patients with favourable prognostic factors. Hypofractionated regimens should be the standard. RT omission, partial breast irradiation (PBI), and ultra- hypofractionated regimens could be considered in selected cases due to the pandemic.


Subject(s)
Breast Neoplasms , COVID-19 , Radiation Oncology , Aged , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Humans , Italy , Mastectomy, Segmental , Neoplasm Recurrence, Local , Radiotherapy, Adjuvant , SARS-CoV-2 , Systematic Reviews as Topic
12.
JAMA Netw Open ; 4(3): e213304, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1155203

ABSTRACT

Importance: During the COVID-19 pandemic, cancer therapy may put patients at risk of SARS-CoV-2 infection and mortality. The impacts of proposed alternatives on reducing infection risk are unknown. Objective: To investigate how the COVID-19 pandemic is associated with the risks and benefits of standard radiation therapy (RT). Design, Setting, and Participants: This comparative effectiveness study used estimated individual patient-level data extracted from published Kaplan-Meier survival figures from 8 randomized clinical trials across oncology from 1993 to 2014 that evaluated the inclusion of RT or compared different RT fractionation regimens. Included trials were Dutch TME and TROG 01.04 examining rectal cancer; CALGB 9343, OCOG hypofractionation trial, FAST-Forward, and NSABP B-39 examining early stage breast cancer, and CHHiP and HYPO-RT-PC examining prostate cancer. Risk of SARS-CoV-2 infection and mortality associated with receipt of RT in the treatment arms were simulated and trials were reanalyzed. Data were analyzed between April 1, 2020, and June 30, 2020. Exposures: COVID-19 risk associated with treatment was simulated across different pandemic scenarios, varying infection risk per fractions (IRFs) and case fatality rates (CFRs). Main Outcomes and Measures: Overall survival was evaluated using Cox proportional hazards modeling under different pandemic scenarios. Results: Estimated IPLD from a total of 14 170 patients were included in the simulations. In scenarios with low COVID-19-associated risks (IRF, 0.5%; CFR, 5%), fractionation was not significantly associated with outcomes. In locally advanced rectal cancer, short-course RT was associated with better outcomes than long-course chemoradiation (TROG 01.04) and was associated with similar outcomes as RT omission (Dutch TME) in most settings (eg, TROG 01.04 median HR, 0.66 [95% CI, 0.46-0.96]; Dutch TME median HR, 0.91 [95% CI, 0.80-1.03] in a scenario with IRF 5% and CFR 20%). Moderate hypofractionation in early stage breast cancer (OCOG hypofractionation trial) and prostate cancer (CHHiP) was not associated with survival benefits in the setting of COVID-19 (eg, OCOG hypofractionation trial median HR, 0.89 [95% CI, 0.74-1.06]; CHHiP median HR, 0.87 [95% CI, 0.75-1.01] under high-risk scenario with IRF 10% and CFR 30%). More aggressive hypofractionation (FAST-Forward, HYPO-RT-PC) and accelerated partial breast irradiation (NSABP B-39) were associated with improved survival in higher risk scenarios (eg, FAST-Forward median HR, 0.58 [95% CI, 0.49-0.68]; HYPO-RT-PC median HR, 0.60 [95% CI, 0.48-0.75] under scenario with IRF 10% and CFR 30%). Conclusions and Relevance: In this comparative effectiveness study of data from 8 clinical trials of patients receiving radiation therapy to simulate COVID-19 risk and mortality rates, treatment modification was not associated with altered risk from COVID-19 in lower-risk scenarios and was only associated with decreased mortality in very high COVID-19-risk scenarios. This model, which can be adapted to dynamic changes in COVID-19 risk, provides a flexible, quantitative approach to assess the potential impact of treatment modifications and supports the continued delivery of standard evidence-based care with appropriate precautions against COVID-19.


Subject(s)
Breast Neoplasms/radiotherapy , COVID-19 , Dose Fractionation, Radiation , Pandemics , Patient Care/methods , Prostatic Neoplasms/radiotherapy , Rectal Neoplasms/radiotherapy , Algorithms , COVID-19/mortality , COVID-19/prevention & control , Comparative Effectiveness Research , Datasets as Topic , Female , Humans , Infection Control , Male , Proportional Hazards Models , Radiation Dose Hypofractionation , Radiology , Randomized Controlled Trials as Topic , Risk , Risk Assessment , Standard of Care
14.
Sci Rep ; 11(1): 5282, 2021 03 05.
Article in English | MEDLINE | ID: covidwho-1118819

ABSTRACT

In this study, we evaluated the effectiveness of palliative breast radiation therapy (RT), with single fraction RT compared with fractionated RT. Our study showed that both RT fractionation schemas provide palliation. Single fraction RT allowed for treatment with minimal interference with systemic therapy, whereas fractionated RT provided a more durable palliative response. Due to equivalent palliative response, at our institution we have increasingly been providing single fraction RT palliation during the COVID-19 pandemic.


Subject(s)
Breast Neoplasms/radiotherapy , Electrons/therapeutic use , Neoplasm Recurrence, Local/radiotherapy , Palliative Care/methods , Photons/therapeutic use , Radiodermatitis/epidemiology , Adult , Aged , Aged, 80 and over , Breast/pathology , Breast/radiation effects , Breast Neoplasms/pathology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Dose Fractionation, Radiation , Dose-Response Relationship, Radiation , Electrons/adverse effects , Female , Follow-Up Studies , Humans , Infection Control/standards , Middle Aged , Neoplasm Recurrence, Local/pathology , Pandemics/prevention & control , Photons/adverse effects , Radiation Oncology/standards , Radiodermatitis/etiology , Retrospective Studies , Treatment Outcome
16.
Eur Rev Med Pharmacol Sci ; 24(23): 12480-12489, 2020 12.
Article in English | MEDLINE | ID: covidwho-995004

ABSTRACT

COVID-19 disease is one of the biggest public health challenges in Italy and global healthcare facilities, including radiotherapy departments, faced an unprecedented emergency. Cancer patients are at higher risk of COVID-19 infection because of their immunosuppressive state caused by both tumor itself and anticancer therapy adopted. In this setting, the radiation therapy clinical decision-making process has been partly reconsidered; thus, to reduce treatment duration and minimize infection risk during a pandemic, hypofractionated regimens have been revised. Moreover, telemedicine shows its helpfulness in the radiotherapy field, and patients get the supportive care they need minimizing their access to hospitals. This review aims to point out the importance of hypofractionated RT and telemedicine in cancer patient management in the COVID-19 era.


Subject(s)
COVID-19 , Neoplasms/radiotherapy , Radiation Dose Hypofractionation , Radiation Oncology/methods , Radiotherapy/methods , Telemedicine/methods , Bone Neoplasms/radiotherapy , Bone Neoplasms/secondary , Brachytherapy/methods , Brain Neoplasms/radiotherapy , Brain Neoplasms/secondary , Breast Neoplasms/radiotherapy , Clinical Decision-Making , Delivery of Health Care , Female , Humans , Male , Practice Guidelines as Topic , Prostatic Neoplasms/radiotherapy , Radiosurgery/methods , Radiotherapy, Conformal/methods , Radiotherapy, Intensity-Modulated/methods , SARS-CoV-2 , Time-to-Treatment
19.
JCO Glob Oncol ; 6: 1696-1703, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-914174

ABSTRACT

PURPOSE: There is a shortage of radiation therapy service centers in low- to middle-income countries. TARGIT-intraoperative radiation therapy (IORT) may offer a viable alternative to improve radiation treatment efficiency and alleviate hospital patient loads. The Breast Care Unit in Johannesburg became the first facility in Africa to offer TARGIT-IORT, and the purpose of this study was to present a retrospective review of patients receiving IORT at this center between November 2017 and May 2020. PATIENTS AND METHODS: Patient selection criteria were based mainly on the latest American Society of Radiation Oncology guidelines. Selection criteria included early-stage breast carcinoma (luminal A) and luminal B with negative upfront sentinel lymph node biopsy that negated external-beam radiation therapy (EBRT). Patient characteristics, reasons for choosing IORT, histology, and use of oncoplastic surgery that resulted in complications were recorded. RESULTS: One hundred seven patients successfully received IORT/TARGIT-IORT. Mean age was 60.8 years (standard deviation, 9.3 years). A total of 73.8% of patients presented with luminal A, 15.0% with luminal B, and 5.6% with triple-negative cancer. One patient who presented with locally advanced breast cancer (T4N2) opted for IORT as a boost in addition to planned EBRT. Eighty-seven patients underwent wide local excision (WLE) with mastopexy, and 12 underwent WLE with parenchymal. Primary reasons for selecting IORT/TARGIT-IORT were distance from the hospital (43.9%), choice (40.2%), and age (10.3%). CONCLUSION: This retrospective study of IORT/TARGIT-IORT performed in Africa confirms its viability, with low complication rates and no detrimental effects with breast conservation, resulting in positive acceptance and the potential to reduce Oncology Center patient loads. Limitations of the study include the fact that only short-term data on local recurrence were available. Health and socioeconomic value models must still be addressed in the African setting.


Subject(s)
Breast Neoplasms/radiotherapy , COVID-19/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Pandemics , Adult , Breast Neoplasms/complications , Breast Neoplasms/surgery , Breast Neoplasms/virology , COVID-19/complications , COVID-19/surgery , COVID-19/virology , Female , Humans , Intraoperative Care , Mastectomy, Segmental , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/virology , Patient Selection , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , SARS-CoV-2/pathogenicity , South Africa/epidemiology
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