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1.
Curr Oncol ; 29(2): 1080-1092, 2022 02 13.
Article in English | MEDLINE | ID: covidwho-1686629

ABSTRACT

The pandemic raised a discussion about the postponement of medical interventions for non-small cell lung cancer (NSCLC). We analyzed the characteristics of pretreatment diagnostic assessment in the pandemic and the influence of diagnostic assessment on outcomes. A total of 96 patients with stereotactic body radiation therapy (SBRT) for NSCLC were included. The number of patients increased from mean 0.9 (2012-2019) to 1.45 per month in the COVID era (p < 0.05). Pandemic-related factors (contact reduction, limited intensive care unit resources) might have influenced clinical decision making towards SBRT. The time from pretreatment assessment (multidisciplinary tumor board decision, bronchoscopy, planning CT) to SBRT was longer during the COVID period (p < 0.05). Reduced services, staff shortage, or appointment management to mitigate infection risks might explain this finding. Overall survival, progression-free survival, locoregional progression-free survival, and distant progression-free survival were superior in patients who received a PET/CT scan prior to SBRT (p < 0.05). This supports that SBRT guidelines advocate the acquisition of a PET/CT scan. A longer time from PET/CT scan/conventional staging to SBRT (<10 vs. ≥10 weeks) was associated with worse locoregional control (p < 0.05). The postponement of diagnostic or therapeutic measures in the pandemic should be discussed cautiously. Patient- and tumor-related features should be evaluated in detail.


Subject(s)
COVID-19 , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Radiosurgery , Carcinoma, Non-Small-Cell Lung/pathology , Follow-Up Studies , Humans , Lung Neoplasms/pathology , Neoplasm Staging , Pandemics , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Radiosurgery/adverse effects , SARS-CoV-2
2.
Clin Genitourin Cancer ; 20(2): 123-131, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1654189

ABSTRACT

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; ∼44 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 Analysis
3.
Int J Radiat Oncol Biol Phys ; 109(3): 756-763, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1318870

ABSTRACT

PURPOSE: Fewer attendances for radiation therapy results in increased efficiency and less foot traffic within a radiation therapy department. We investigated outcomes after single-fraction (SF) stereotactic body radiation therapy (SBRT) in patients with oligometastatic disease. METHODS AND MATERIALS: Between February 2010 and June 2019, patients who received SF SBRT to 1 to 5 sites of oligometastatic disease were included in this retrospective study. The primary objective was to describe patterns of first failure after SBRT. Secondary objectives included overall survival (OS), progression-free survival (PFS), high-grade treatment-related toxicity (Common Terminology Criteria for Adverse Events grade ≥3), and freedom from systemic therapy (FFST). RESULTS: In total, 371 patients with 494 extracranial oligometastases received SF SBRT ranging from 16 Gy to 28 Gy. The most common primary malignancies were prostate (n = 107), lung (n = 63), kidney (n = 52), gastrointestinal (n = 51), and breast cancers (n = 42). The median follow-up was 3.1 years. The 1-, 3-, and 5-year OS was 93%, 69%, and 55%, respectively; PFS was 48%, 19%, and 14%, respectively; and FFST was 70%, 43%, and 35%, respectively. Twelve patients (3%) developed grade 3 to 4 treatment-related toxicity, with no grade 5 toxicity. As the first site of failure, the cumulative incidence of local failure (irrespective of other failures) at 1, 3 and 5 years was 4%, 8%, and 8%, respectively; locoregional relapse at the primary was 10%, 18%, and 18%, respectively; and distant failure was 45%, 66%, and 70%, respectively. CONCLUSIONS: SF SBRT is safe and effective, and a significant proportion of patients remain FFST for several years after therapy. This approach could be considered in resource-constrained or bundled-payment environments. Locoregional failure of the primary site is the second most common pattern of failure, suggesting a role for optimization of primary control during metastasis-directed therapy.


Subject(s)
Neoplasm Metastasis/radiotherapy , Radiosurgery/methods , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Neoplasms/radiotherapy , Neoplasms/surgery , Pandemics , Progression-Free Survival , Radiation Injuries/pathology , Radiosurgery/adverse effects , Radiotherapy Dosage , Retrospective Studies , Salvage Therapy , Treatment Failure , Young Adult
4.
J Appl Clin Med Phys ; 22(6): 274-280, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1239974

ABSTRACT

Thermoplastic masks, used along with surgical masks, enable immobilization methods to reduce the risk of infection in patients undergoing intracranial stereotactic radiosurgery and stereotactic radiotherapy (SRS/SRT) during the COVID-19 crisis. The purpose of this study was to investigate the feasibility of thermoplastic mask immobilization with a surgical mask using an ExacTrac system. Twelve patients each with brain metastases were immobilized using a thermoplastic mask and a surgical mask and only a thermoplastic mask. Two x-ray images were acquired to correct (XC) and verify (XV) the patient's position at a couch angle of 0°. Subsequently, the XC and XV images were acquired at each planned couch angle for non-coplanar beams. When the position errors were detected after couch rotation for non-coplanar beams, the errors were corrected at each planned couch angle until a clinically acceptable tolerance was attained. The position errors in the translational and rotational directions (vertical, lateral, longitudinal, pitch, roll, and yaw) were retrospectively investigated using data from the ExacTrac system database. A standard deviation of XC translational and rotational position errors with and without a surgical mask in the lateral (1.52 vs 2.07 mm), longitudinal (1.59 vs 1.87 mm), vertical (1.00 vs 1.73 mm), pitch (0.99 vs 0.79°), roll (1.24 vs 0.68°), and yaw (1.58 vs 0.90°) directions were observed at a couch angle of 0°. Most of patient positioning errors were less than 1.0 mm or 1.0° after the couch was rotated to the planned angle for non-coplanar beams. The overall absolute values of the translational and rotational XV position errors with and without the surgical mask were less than 0.5 mm and 0.5°, respectively. This study showed that a thermoplastic mask with a surgical mask is a feasible immobilization technique for brain SRS/SRT patients using the ExacTrac system.


Subject(s)
Brain Neoplasms , COVID-19 , Radiosurgery , Brain Neoplasms/radiotherapy , Brain Neoplasms/surgery , Humans , Immobilization , Masks , Patient Positioning , Radiotherapy Planning, Computer-Assisted , Radiotherapy Setup Errors/prevention & control , Retrospective Studies , SARS-CoV-2 , Uncertainty
5.
Med Dosim ; 46(4): 374-376, 2021.
Article in English | MEDLINE | ID: covidwho-1179897

ABSTRACT

In this brief report, we describe the case of a previously healthy 51-year gentleman who was treated with stereotactic radiosurgery to a dose of 12 Gy to a small right-sided vestibular schwannoma. MRI of the brain performed after treatment revealed stable treated disease but subsequently, the patient developed symptomatic COVID-19 based on PCR along with multiple cranial neurologic deficits, including right facial paralysis, hemifacial anesthesia, and anesthesia of the ipsilateral hard palate and tongue. MRI of the brain was repeated and demonstrated radiation necrosis in the adjacent brainstem for which he was treated with Pentoxifylline and Vitamin E, dexamethasone, and Bevacizumab with only partial improvement. The dose-volume metrics of the brainstem from his radiotherapy plan as well as the trajectory of his imaging findings do not match this clinical picture from radiotherapy alone. We review the basic pathogenesis of the inflammatory response to infection from the SARS-CoV-2 virus as well as the pathogenesis of radiation necrosis. Heightened awareness about potential risks with high-dose radiotherapy in patients with symptomatic COVID-19 should be considered.


Subject(s)
COVID-19 , Radiosurgery , Humans , Male , Necrosis , Radiosurgery/adverse effects , Radiotherapy Planning, Computer-Assisted , SARS-CoV-2
6.
Int J Radiat Oncol Biol Phys ; 110(4): 957-961, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1116868

ABSTRACT

Radiation recall phenomenon (RRP) is an uncommon, late occurring, acute inflammatory skin reaction that emerges in localized areas coincident with previously irradiated radiation therapy (RT) treatment fields. RRP has been known to be triggered by a number of chemotherapy agents. To the best of our knowledge, this report is the first description of RRP after administration of the Pfizer-BioNTech vaccine for COVID-19, or any other currently available vaccine against COVID-19. Acute skin reactions were observed in 2 RT patients with differing timelines of RT and vaccinations. In both cases however, the RRP presented within days of the patient receiving the second dose of vaccine. For each RT course, the treatment planning dosimetry of the radiation fields was compared with the area of the observable RRP. RRP developed within the borders of treatment fields where prescription dose constraints were prioritized over skin sparing. Our observation is currently limited to 2 patients. The actual incidence of RRP in conjunction with Pfizer-BioNTech vaccine or any other vaccine against COVID-19 is unknown. For patients with cancer being treated with radiation with significant dose to skin, consideration should be given to the probability of RRP side effects from vaccinations against COVID-19.


Subject(s)
COVID-19 Vaccines/adverse effects , Immunization, Secondary/adverse effects , Lung Neoplasms/radiotherapy , Radiodermatitis/etiology , Sarcoma/radiotherapy , Skin Neoplasms/radiotherapy , Aged , COVID-19 Vaccines/administration & dosage , Humans , Immunization Schedule , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Radiodermatitis/pathology , Radiosurgery/methods , Sarcoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Spinal Cord Compression/surgery , Thoracic Wall
7.
Neurosurgery ; 88(4): E351-E355, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1029644

ABSTRACT

BACKGROUND AND IMPORTANCE: The Zap-X system (Zap Surgical Systems Inc, San Carlos, California) is a radically new surgical robot designed for brain and head and neck radiosurgery. It represents the first new dedicated brain stereotactic radiosurgery platform in almost half a century optimizing the goals of safety, speed, and accuracy. The Zap-X system was used in a required Chinese National Medical Products Administration clinical study. In early January 2020, 2 patients were treated with the Zap-X robot prior to a national COVID-19 lockdown. Both were closely followed via clinical exam and magnetic resonance imaging (MRI) imaging. Prospectively collected data were used to generate this report. CLINICAL PRESENTATION: Two female patients, each harboring either a trigeminal schwannoma or petroclival meningioma, were treated with the Zap-X robot. Respective tumor volumes were 2.60 and 4.02 cm3. A radiation dose of 13 Gy was prescribed to the 50% isodose line. At 8 mo of follow-up, preoperative symptoms were either resolved or stable and MRI imaging demonstrated a 31% and 56% reduction in lesion volume, respectively. In both patients, symptoms improved, and tumor volumes decreased, whereas no major complication was observed. CONCLUSION: Given only 2 patients and short-term follow-up, any conclusions about the safety and efficacy of the Zap-X radiosurgery robot are preliminary. However, in the absence of any other published outcomes to date, this small case series may be of interest to many radiosurgical specialists.


Subject(s)
Brain Neoplasms , COVID-19 , Meningeal Neoplasms , Meningioma , Radiosurgery , Communicable Disease Control , Female , Humans , Meningeal Neoplasms/surgery , Meningioma/surgery , SARS-CoV-2
8.
Curr Oncol ; 27(3): e313-e317, 2020 06.
Article in English | MEDLINE | ID: covidwho-1024671

ABSTRACT

Background: The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non-covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services in the province of Quebec under the direction of the Ministère de la Santé et des Services sociaux, convened to develop recommendations to deal with the potential disruption of services in thoracic oncology in the province of Quebec. The summary provided here has been adapted from the original document posted on the Programme québécois du cancer Web site at: https://www.msss.gouv.qc.ca/professionnels/documents/coronavirus-2019-ncov/PJ1_Recommandations_oncologie-thoracique-200415.pdf. Methods: Plans to optimize the health care system and potentially to prioritize services were discussed with respect to various levels of activity. For each level-of-activity scenario, suggestions were made for the services and treatments to prioritize and for those that might have to be postponed, as well as for potential alternatives to care. Results: The principal recommendation is that the cancer centre executive committee and the multidisciplinary tumour board always try to find a solution to maintain standard-of-care therapy for all patients with thoracic tumours, using novel approaches to treatment and the adoption of a network approach to care, as needed. Conclusions: The effect of the covid-19 pandemic on the health care system remains unpredictable and requires that cancer teams unite and offer the most efficient and innovative therapies to all patients under the various conditions that might be forced upon them.


Subject(s)
Antineoplastic Agents/administration & dosage , Carcinoma, Non-Small-Cell Lung/therapy , Coronavirus Infections/epidemiology , Lung Neoplasms/therapy , Pneumonia, Viral/epidemiology , Radiotherapy , Small Cell Lung Carcinoma/therapy , Thoracic Surgical Procedures , Triage , Administration, Oral , Antineoplastic Agents/therapeutic use , Betacoronavirus , COVID-19 , Carcinoma, Non-Small-Cell Lung/diagnosis , Disease Management , Humans , Lung Neoplasms/diagnosis , Mediastinoscopy , Medical Oncology , Molecular Diagnostic Techniques , Neoplasm Staging , Pandemics , Quebec/epidemiology , Radiosurgery , SARS-CoV-2 , Small Cell Lung Carcinoma/diagnosis , Thoracoscopy
9.
J Radiat Res ; 62(1): 163-171, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1003611

ABSTRACT

The immobilization of patients with a bite block (BB) carries the risk of interpersonal infection, particularly in the context of pandemics such as COVID-19. Here, we compared the intra-fractional patient setup error (intra-SE) with and without a BB during fractionated intracranial stereotactic irradiation (STI). Fifteen patients with brain metastases were immobilized using a BB without a medical mask, while 15 patients were immobilized without using a BB and with a medical mask. The intra-SEs in six directions (anterior-posterior (AP), superior-inferior (SI), left-right (LR), pitch, roll, and yaw) were calculated by using cone-beam computed tomography images acquired before and after the treatments. We analyzed a total of 53 and 67 treatment sessions for the with- and without-BB groups, respectively. A comparable absolute mean translational and rotational intra-SE was observed (P > 0.05) in the AP (0.19 vs 0.23 mm with- and without-BB, respectively), SI (0.30 vs 0.29 mm), LR (0.20 vs 0.29 mm), pitch (0.18 vs 0.27°), roll (0.23 vs 0.23°) and yaw (0.27 vs 22°) directions. The resultant planning target volume (PTV) margin to compensate for intra-SE was <1 mm. No statistically significant correlation was observed between the intra-SE and treatment times. A PTV margin of <1 mm was achieved even when patients were immobilized without a BB during STI dose delivery.


Subject(s)
COVID-19 , Cranial Irradiation , Dose Fractionation, Radiation , Immobilization/instrumentation , Masks/adverse effects , Pandemics , Patient Positioning/instrumentation , Radiosurgery , Radiotherapy Setup Errors , Adult , Aged , Aged, 80 and over , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/radiotherapy , Brain Neoplasms/secondary , COVID-19/prevention & control , Equipment Design , Female , Humans , Male , Middle Aged , Radiotherapy Planning, Computer-Assisted/methods , Retrospective Studies , Tomography, X-Ray Computed
10.
World Neurosurg ; 148: e197-e208, 2021 04.
Article in English | MEDLINE | ID: covidwho-989401

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has been at its peak for the past 8 months and has affected more than 215 countries around the world. India is now the second most-affected nation with more than 48,000,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation, the number of deaths is almost one third that of the United States and one half that of Brazil. However, there has been no experience published from non-COVID-19-designated hospitals, where the aim is to manage noninfected cases with neurosurgical ailments while keeping the number of infected cases to a minimum. METHODS: We analyzed the number of neurosurgical cases (nontrauma) done in the past 5 months (March-July 2020) in our institute, which is the largest neurosurgical center by volume in southern India, and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time. RESULTS: We operated a total of 630 cases (nontrauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (P = 0.002) reduction in the number of cases operated as compared with the same 5 months in the preceding year. We employed a dual strategy of rapid antigen testing and surgery for cases needing emergency intervention and reverse transcriptase-polymerase chain reaction test for elective cases. The hospital was divided into 3 zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone, and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists. CONCLUSIONS: We present a patient management protocol for non-COVID-19-designated hospitals in high-volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.


Subject(s)
COVID-19/epidemiology , Neurosurgical Procedures/trends , Telemedicine/trends , Tertiary Care Centers/organization & administration , Ambulatory Care/trends , Aneurysm, Ruptured/surgery , Brain Neoplasms/surgery , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Cerebrovascular Disorders/surgery , Humans , India/epidemiology , Infection Control , Intracranial Aneurysm/surgery , Neural Tube Defects/surgery , Patient Selection , Personal Protective Equipment , Radiosurgery , SARS-CoV-2 , Spinal Diseases , Spinal Injuries
11.
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
12.
Clin Oncol (R Coll Radiol) ; 33(5): 283-291, 2021 05.
Article in English | MEDLINE | ID: covidwho-978251

ABSTRACT

AIMS: To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS: Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS: In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS: SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.


Subject(s)
Carcinoma, Non-Small-Cell Lung/mortality , Lung Neoplasms/mortality , Radiosurgery/mortality , Aged , Aged, 80 and over , Cancer Care Facilities , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/surgery , Female , Four-Dimensional Computed Tomography , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Radiosurgery/methods , Retrospective Studies , Survival Rate
14.
Strahlenther Onkol ; 196(12): 1080-1085, 2020 12.
Article in English | MEDLINE | ID: covidwho-928408

ABSTRACT

PURPOSE: The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV­2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS: The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS: Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV­2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION: In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.


Subject(s)
Appointments and Schedules , COVID-19/prevention & control , Cross Infection/prevention & control , Hospitals, University/organization & administration , Infection Control/organization & administration , Neoplasms/radiotherapy , Outpatient Clinics, Hospital/organization & administration , Pandemics , Radiation Oncology/organization & administration , Radiology Department, Hospital/organization & administration , SARS-CoV-2/isolation & purification , Workflow , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/statistics & numerical data , Cross Infection/epidemiology , Dose Fractionation, Radiation , Germany/epidemiology , Hospitals, University/statistics & numerical data , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Neoplasms/surgery , Outpatient Clinics, Hospital/statistics & numerical data , Personal Protective Equipment , Procedures and Techniques Utilization , Radiology Department, Hospital/statistics & numerical data , Radiosurgery/statistics & numerical data , Radiotherapy/statistics & numerical data , Triage/methods , Triage/standards
15.
Neurol India ; 68(5): 1008-1011, 2020.
Article in English | MEDLINE | ID: covidwho-895443

ABSTRACT

BACKGROUND: The world is in the midst of the COVID crisis, which has forced the neurosurgical community to change its practices. OBJECTIVE: To advocate the necessary adaptations in radio surgical practices to effectively manage the radio surgical patients, resource utilization, and protecting the healthcare provider during the COVID pandemic. MATERIAL AND METHODS: In addition to the literature review, pertinent recommendations are made in respect to the gamma knife radiosurgery (GKRS). RESULTS: Every patient presenting to GKRS treatment should be considered as a potential asymptomatic COVID carrier. Patients should be categorized based on the priority (urgent, semi-urgent, or elective) on the basis of pathological and clinical status. The only urgent indication is a non-responding or enlarging cerebral metastasis. There is a high risk of aerosol dispersion during gamma radiation delivery in the gamma gantry. CONCLUSION: These recommendations should be used to minimize the chances of pathogenic exposure to the patient and caregivers both.


Subject(s)
COVID-19 , Radiosurgery , Humans , SARS-CoV-2 , Treatment Outcome
16.
Ann Surg ; 272(6): 925-929, 2020 12.
Article in English | MEDLINE | ID: covidwho-873175

ABSTRACT

OBJECTIVE: To evaluate the overall survival of patients with operable stage IA non-small-cell lung cancer (NSCLC) who undergo "early" SBRT (within 0-30 days after diagnosis) versus "delayed" surgery (90-120 days after diagnosis). SUMMARY OF BACKGROUND DATA: During the COVID-19 pandemic, national guidelines have recommended patients with operable stage IA NSCLC to consider delaying surgery by at least 3 months or, alternatively, to undergo SBRT without delay. It is unknown which strategy is associated with better short- and long-term outcomes. METHODS: Multivariable Cox proportional hazards modeling and propensity score-matched analysis was used to compare the overall survival of patients with stage IA NSCLC in the National Cancer Data Base from 2004 to 2015 who underwent "early" SBRT (0-30 days after diagnosis) versus that of patients who underwent "delayed" wedge resection (90-120 days after diagnosis). RESULTS: During the study period, 570 (55%) patients underwent early SBRT and 475 (45%) underwent delayed wedge resection. In multivariable analysis, delayed resection was associated with improved survival [adjusted hazard ratio 0.61; (95% confidence interval (CI): 0.50-0.76)]. Propensity-score matching was used to create 2 groups of 279 patients each who received early SBRT or delayed resection that were well-matched with regard to baseline characteristics. The 5-year survival associated with delayed resection was 53% (95% CI: 45%-61%) which was better than the 5-year survival associated with early SBRT (31% [95% CI: 24%-37%]). CONCLUSION: In this national analysis, for patients with stage IA NSCLC, extended delay of surgery was associated with improved survival when compared to early treatment with SBRT.


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/radiotherapy , Lung Neoplasms/surgery , Radiosurgery , COVID-19 , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Cohort Studies , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Neoplasm Staging , SARS-CoV-2 , Survival Rate , Time Factors , Time-to-Treatment
18.
Stereotact Funct Neurosurg ; 98(5): 319-323, 2020.
Article in English | MEDLINE | ID: covidwho-690390

ABSTRACT

INTRODUCTION: The WHO declared 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a public health emergency of international concern. The National and Regional Health System has been reorganized, and many oncological patients died during this period or had to interrupt their therapies. This study summarizes a single-centre experience, during the COVID-19 period in Italy, in the treatment of brain metastases with Gamma Knife stereotactic radiosurgery (GKRS). METHODS: We retrospectively analysed our series of patients with brain metastases who underwent GKRS at the Niguarda Hospital from February 24 to April 24, 2020. RESULTS: We treated 30 patients with 66 brain metastases. A total of 22 patients came from home and 8 patients were admitted to the emergency room for urgent neurological symptoms. Duration of stay was limited to 0-1 day in 17 patients. We chose to treat a cluster of 9 patients, whose greater lesion exceeded 10 cm3, with 2-stage modality GKRS to minimize tumour recurrence and radiation necrosis. CONCLUSION: Due to the COVID-19 pandemic, the whole world is at a critical crossroads about the use of health care resources. During the COVID-19 outbreak, the deferral of diagnostic and therapeutic procedures and a work backlog in every medical specialty are the natural consequences of reservation of resources for COVID-19 patients. GKRS improved symptoms and reduced the need for open surgeries, allowing many patients to continue their therapeutic path and sparing beds in ICUs. Neurosurgeons have to take into account the availability of stereotactic radiosurgery to reduce hospital stay, conciliating safety for patients and operators with the request for health care coming from the oncological patients and their families.


Subject(s)
Brain Neoplasms/radiotherapy , Coronavirus Infections , Pandemics , Pneumonia, Viral , Radiosurgery/methods , Aged , Betacoronavirus , Brain Neoplasms/secondary , COVID-19 , Female , Humans , Italy , Male , Middle Aged , Neoplasm Recurrence, Local/surgery , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
19.
ESMO Open ; 5(Suppl 3)2020 06.
Article in English | MEDLINE | ID: covidwho-615335

ABSTRACT

The COVID-19 pandemic, characterised by a fast and global spread during the first months of 2020, has prompted the development of a structured set of recommendations for cancer care management, to maintain the highest possible standards. Within this framework, it is crucial to ensure no disruption to essential oncological services and guarantee the optimal care.This is a structured proposal for the management of lung cancer, comprising three levels of priorities, namely: tier 1 (high priority), tier 2 (medium priority) and tier 3 (low priority)-defined according to the criteria of the Cancer Care Ontario, Huntsman Cancer Institute and Magnitude of Clinical Benefit Scale.The manuscript emphasises the impact of the COVID-19 pandemic on lung cancer care and reconsiders all steps from diagnosis, staging and treatment.These recommendations should, therefore, serve as guidance for prioritising the different aspects of cancer care to mitigate the possible negative impact of the COVID-19 pandemic on the management of our patients.As the situation is rapidly evolving, practical actions are required to guarantee the best patients' treatment while protecting and respecting their rights, safety and well-being. In this environment, cancer practitioners have great responsibilities: provide timely, appropriate, compassionate and justified cancer care, while protecting themselves and their patients from being infected with COVID-19. In case of shortages, resources must be distributed fairly. Consequently, the following recommendations can be applied with significant nuances, depending on the time and location for their use, considering variable constraints imposed to the health systems. An exceptional flexibility is required from cancer caregivers.


Subject(s)
Carcinoma, Non-Small-Cell Lung/therapy , Coronavirus Infections/epidemiology , Delivery of Health Care/methods , Lung Neoplasms/therapy , Pneumonia, Viral/epidemiology , Small Cell Lung Carcinoma/therapy , Ambulatory Care , Betacoronavirus , COVID-19 , Carcinoma, Non-Small-Cell Lung/pathology , Chemoradiotherapy , Humans , Lung Neoplasms/pathology , Medical Oncology , Neoplasm Staging , Pandemics , Pneumonectomy , Practice Guidelines as Topic , Radiation Oncology , Radiosurgery , SARS-CoV-2 , Small Cell Lung Carcinoma/pathology , Surgical Oncology , Telemedicine , Time-to-Treatment , Tomography, X-Ray Computed , Triage
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