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1.
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
3.
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
4.
Strahlenther Onkol ; 196(12): 1096-1102, 2020 12.
Article in English | MEDLINE | ID: covidwho-1018215

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 24 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 Irradiation
5.
Technol Cancer Res Treat ; 19: 1533033820974021, 2020.
Article in English | MEDLINE | ID: covidwho-983619

ABSTRACT

PURPOSE: With the widespread prevalence of Corona Virus Disease 2019 (COVID-19), cancer patients are suggested to wear a surgical mask during radiation treatment. In this study, cone beam CT (CBCT) was used to investigate the effect of surgical mask on setup errors in head and neck radiotherapy. METHODS: A total of 91 patients with head and neck tumors were selected. CBCT was performed to localize target volume after patient set up. The images obtained by CBCT before treatment were automatically registered with CT images and manually fine-tuned. The setup errors of patients in 6 directions of Vrt, Lng, Lat, Pitch, Roll and Rotation were recorded. The patients were divided into groups according to whether they wore the surgical mask, the type of immobilization mask used and the location of the isocenter. The setup errors of patients were calculated. A t-test was performed to detect whether it was statistically significant. RESULTS: In the 4 groups, the standard deviation in the directions of Lng and Pitch of the with surgical mask group were all higher than that in the without surgical mask group. In the head-neck-shoulder mask group, the mean in the Lng direction of the with surgical mask group was larger than that of the without surgical mask group. In the lateral isocenter group, the mean in the Lng and Pitch directions of the with surgical mask group were larger than that of the without surgical mask group. The t-test results showed that there was significant difference in the setup error between the 2 groups (p = 0.043 and p = 0.013, respectively) only in the Lng and Pitch directions of the head-neck-shoulder mask group. In addition, the setup error of 6 patients with immobilization open masks exhibited no distinguished difference from that of the patients with regular immobilization masks. CONCLUSION: In the head and neck radiotherapy patients, the setup error was affected by wearing surgical mask. It is recommended that the immobilization open mask should be used when the patient cannot finish the whole treatment with a surgical mask.


Subject(s)
COVID-19/prevention & control , Head and Neck Neoplasms/radiotherapy , Masks , Radiotherapy Setup Errors/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/epidemiology , Case-Control Studies , Cone-Beam Computed Tomography/methods , Female , Head and Neck Neoplasms/epidemiology , Humans , Immobilization/instrumentation , Immobilization/methods , Immobilization/statistics & numerical data , Male , Masks/adverse effects , Masks/statistics & numerical data , Middle Aged , Pandemics , Radiation Oncology/methods , Radiation Oncology/standards , Radiotherapy Planning, Computer-Assisted/adverse effects , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy Planning, Computer-Assisted/statistics & numerical data , Radiotherapy, Image-Guided/adverse effects , Radiotherapy, Image-Guided/methods , Radiotherapy, Image-Guided/statistics & numerical data , Radiotherapy, Intensity-Modulated/methods , SARS-CoV-2/physiology , Shoulder , Young Adult
6.
Tumori ; 107(6): 498-503, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-983620

ABSTRACT

OBJECTIVE: During 2020, medical clinical activities were dramatically modified by the coronavirus disease 2019 (COVID-19) emergency. We aim to evaluate the impact of COVID-19 on radiotherapy (RT) practice in a hub cancer center. METHODS: Retrospective data collection of patients with suspected COVID-19 infection, identified by pathognomonic symptoms feedback at triage realized at the entrance to RT division. Inclusion criteria were diagnosis of oncologic disease, COVID-19-related symptoms, and signed written informed consent. RESULTS: Between 1 March and 30 June 2020, 1,006 patients accessed our RT division for RT simulation or treatment. Forty-four patients matched inclusion criteria (4.4% of all patients): 29 women and 15 men. Seventeen patients had metastatic disease. Twenty-one patients reported fever, 6 presented dyspnea, 4 complained of ageusia and anosmia, and 3 developed conjunctivitis. Thirty-six patients underwent nasal swab, with 7 positive results. From our cohort, 4 cases of pneumonia were diagnosed with computed tomography scan imaging: 3 were related to COVID-19 infection, while the fourth was evaluated as an RT adverse event. From the entire series, 4 patients died: 3 during hospitalization in intensive care unit of complications of COVID-19 and 1 of other causes neither COVID-19 nor cancer-related. CONCLUSIONS: Cancer hub allows for safe RT practice continuation while minimizing the spread of contagion in this frail patient population. A challenge for the future will be to understand pandemic consequences in cancer natural history and manage its clinical impact.


Subject(s)
COVID-19/epidemiology , Neoplasms/radiotherapy , Practice Patterns, Physicians'/standards , Radiation Oncology/standards , Radiotherapy/methods , SARS-CoV-2/isolation & purification , Aged , COVID-19/complications , COVID-19/virology , Disease Management , Female , Humans , Intensive Care Units , Italy/epidemiology , Male , Middle Aged , Neoplasms/virology , Retrospective Studies
7.
Cancer Rep (Hoboken) ; 4(2): e1320, 2021 04.
Article in English | MEDLINE | ID: covidwho-967725

ABSTRACT

BACKGROUND: COVID-19 outbreak was declared as a pandemic by the World Health Organization in March 2020. Over the last 3 months, the pandemic has challenged the diagnosis and treatment of all cancer, including rectal cancer. Constraints in resources call for a change in the treatment strategy without compromising efficacy. RECENT FINDINGS: Delivery of shorter treatment schedules for radiotherapy offers advantages like short overall treatment time, improved throughput on the machine, improved compliance and reduced risk of transmission of COVID 19. Other strategies include delaying surgery, reducing the intensity of chemotherapy and adoption of organ preservation approach. CONCLUSION: The curative treatment of rectal cancer should not be hindered during the COVID pandemic, and modifications in the multi-modality treatment will help achieve quality care.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/standards , Pandemics/prevention & control , Radiation Oncology/organization & administration , Rectal Neoplasms/therapy , COVID-19/epidemiology , COVID-19/transmission , Chemoradiotherapy, Adjuvant/methods , Chemoradiotherapy, Adjuvant/standards , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neoadjuvant Therapy/methods , Neoadjuvant Therapy/standards , Organ Sparing Treatments/methods , Organ Sparing Treatments/standards , Personal Protective Equipment/standards , Radiation Oncology/methods , Radiation Oncology/standards , Radiotherapy, Adjuvant/methods , Radiotherapy, Adjuvant/standards , Rectal Neoplasms/diagnosis , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/standards , Time Factors , Time-to-Treatment/standards , Treatment Outcome
10.
Med Oncol ; 37(9): 76, 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-691683

ABSTRACT

We here express our concern about a general decree to let patients wear face masks in radiation oncology clinics. We believe that potential risks associated with wearing masks, such as the risk of confounding patients, outweigh any benefits of such a policy for which evidence of protection from COVID-19 is generally weak. For asymptomatic patients, wearing masks in addition to hygiene standards will not provide additional protection of others and should be cautioned against.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Evidence-Based Medicine , Masks/statistics & numerical data , Masks/standards , Pneumonia, Viral/epidemiology , Radiation Oncology/standards , Radiotherapy Setup Errors/prevention & control , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2
11.
Gynecol Oncol ; 158(2): 244-253, 2020 08.
Article in English | MEDLINE | ID: covidwho-598729

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.


Subject(s)
Coronavirus Infections/prevention & control , Genital Neoplasms, Female/radiotherapy , Genital Neoplasms, Female/virology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Radiation Oncology/methods , Radiation Oncology/standards , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Female , Humans , Infection Control/methods , Infection Control/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2
12.
Indian J Cancer ; 57(2): 221-223, 2020.
Article in English | MEDLINE | ID: covidwho-350026

ABSTRACT

The practice of radiation oncology requires stringent adherence to specific steps and principles designed to minimize exposure of an individual to unnecessary doses of radiation. The basic principles of such measures to reduce the risk of exposure and limit the doses of irradiation follow the "as low as reasonably achievable " or ALARA principle by using the concepts of time, distance and shielding. Potential exposures in radiation oncology are controlled through combination of optimal design and installation of radiation delivery equipment with well-defined standard operating procedures (SOPs). In the modern era of viral pandemics, similar principles can also be applied toward prevention of viral transmission and protection of populations at risk. In the ongoing COVID-19 pandemic, the probability of an individual getting infected is dependent on the viral load that an individual is exposed to in public spaces over a period of time. All prevention and control measures are based on preventing any such exposure to the virus, that can be achieved through limiting space for movement of the virus, using barriers and increasing distance to vulnerable surfaces, and limiting the duration of exposure. Apart from adhering to the laid-down provisions of a lock-down, preventive measures recommended for the general public include maintaining hand-hygiene, social distancing, and using facemasks to break the chain of transmission. Appropriate triage and customization of treatment protocols can help curtail hospital visits and time-spent by cancer patients during pandemic times, thereby reducing their risk of exposure as well as allowing efficient utilization of resources. The outbreak of the contagious COVID-19 pandemic threatens to disrupt healthcare systems globally with its unprecedented challenges. However, despite all the difficulties and hardships, it has also enabled new ways of learning and communication, which are likely to persist even in the post-COVID world.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Radiation Oncology/methods , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , India/epidemiology , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Radiation Oncology/standards , Radiation Protection/methods , Radiation Protection/standards , SARS-CoV-2
13.
J Appl Clin Med Phys ; 21(7): 187-195, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-324503

ABSTRACT

PURPOSE: The COVID-19 pandemic has led to disorder in work and livelihood of a majority of the modern world. In this work, we review its major impacts on procedures and workflow of clinical physics tasks, and suggest alternate pathways to avoid major disruption or discontinuity of physics tasks in the context of small, medium, and large radiation oncology clinics. We also evaluate scalability of medical physics under the stress of "social distancing". METHODS: Three models of facilities characterized by the number of clinical physicists, daily patient throughput, and equipment were identified for this purpose. For identical objectives of continuity of clinical operations, with constraints such as social distancing and unavailability of staff due to system strain, however with the possibility of remote operations, the performance of these models was investigated. General clinical tasks requiring on-site personnel presence or otherwise were evaluated to determine the scalability of the three models at this point in the course of disease spread within their surroundings. RESULTS: The clinical physics tasks within three models could be divided into two categories. The former, which requires individual presence, include safety-sensitive radiation delivery, high dose per fraction treatments, brachytherapy procedures, fulfilling state and nuclear regulatory commission's requirements, etc. The latter, which can be handled through remote means, include dose planning, physics plan review and supervision of quality assurance, general troubleshooting, etc. CONCLUSION: At the current level of disease in the United States, all three models have sustained major system stress in continuing reduced operation. However, the small clinic model may not perform if either the current level of infections is maintained for long or staff becomes unavailable due to health issues. With abundance, and diversity of innovative resources, medium and large clinic models can sustain further for physics-related radiotherapy services.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Health Physics , Pandemics , Pneumonia, Viral/epidemiology , Radiation Oncology , COVID-19 , Health Facilities/standards , Health Personnel , Health Physics/organization & administration , Health Physics/standards , Humans , Practice Guidelines as Topic/standards , Quality Assurance, Health Care , Radiation Oncology/organization & administration , Radiation Oncology/standards , SARS-CoV-2 , United States/epidemiology
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