PRRT and SARS-COV-2 pandemic: could they live together? The experience of European Institute of Oncology (IEO), Milano Italy

ABSTRACT

Background-Aim: The importance of timely assistance in oncological patients is undeniable;however it is well known that these patients could have important clinical problems if they were infected by COVID-19, with an increased risk of severe illness and mortality. A recent multicenter Italian study reported a delay both in the beginning of PRRT for new patients (about 45.5% of centers) and in those ones who had already started the treatment (15%), as a direct consequence of COVID-19. The aim of this study was to understand if SARS-CoV2 infection has modified our clinical management, with particular attention to PRRT. Methods: In our ENETS Center of Excellence, the weekly multidisciplinary tumor board never stopped, also during the pandemic period. During these periods, the patients were treated with PRRT in the same way of previous years, remaining one night in Radiometabolic Therapy Unit, according to local laws. During COVID-19 pandemic, the patients received the PCR test the day before the treatment, while the day of PRRT they received a particular triage for avoid admitting patients with Sars-CoV-2 infection. We made a comparison between the number of PRRT cycles (either in clinical practice or in clinical trials) performed at European Institute of Oncology (IEO) from February 2020 to July 2021, with those performed in the previous year (February 2019-January 2020). Results: From February 2019 to January 2020, we performed 10 PRRT cycles, instead in the following months, during and despite of COVID-19 pandemic, from February 2020 to July 2021, we increased the number of patients treated. In fact 126 PRRT cycles were performed without any delay (either in clinical practice or in clinical trials). Only one Italian patient was unable to receive the treatment at IEO because he couldn't travel during lockdown period, so he performed PRRT near home. On the contrary, another patient coming from a different Nation, received PRRT on time. During this period, only two patients were affected by COVID-19 at the end of the treatment even if they were not yet vaccinated and, fortunately, the disease was mild, without consequences. These patients didn't stopped the therapy with SSA during COVID-19 disease. Moreover we performed a dosimetric study in almost all the patients during the first cycle of PRRT. Conclusions: These results focusing on PRRT treatments and COVID-19 pandemic, show that centers with more experience are able to adapt to the new global situation and to the new rules imposed by governments, providing continuity in care without any delay and even to increase the number of treatments.