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Practice Recommendations for Risk-Adapted Head and Neck Cancer Radiation Therapy During the COVID-19 Pandemic: An ASTRO-ESTRO Consensus Statement.
Thomson, David J; Palma, David; Guckenberger, Matthias; Balermpas, Panagiotis; Beitler, Jonathan J; Blanchard, Pierre; Brizel, David; Budach, Wilfred; Caudell, Jimmy; Corry, June; Corvo, Renzo; Evans, Mererid; Garden, Adam S; Giralt, Jordi; Gregoire, Vincent; Harari, Paul M; Harrington, Kevin; Hitchcock, Ying J; Johansen, Jorgen; Kaanders, Johannes; Koyfman, Shlomo; Langendijk, J A; Le, Quynh-Thu; Lee, Nancy; Margalit, Danielle; Mierzwa, Michelle; Porceddu, Sandro; Soong, Yoke Lim; Sun, Ying; Thariat, Juliette; Waldron, John; Yom, Sue S.
  • Thomson DJ; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, and the Division of Cancer Sciences, The University of Manchester, UK.
  • Palma D; Division of Radiation Oncology, Western University, London, Canada.
  • Guckenberger M; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
  • Balermpas P; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
  • Beitler JJ; Department of Radiation Oncology, Emory University, Atlanta, Georgia.
  • Blanchard P; Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France.
  • Brizel D; Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina.
  • Budach W; Department of Radiation Oncology, University Hospital Düsseldorf, Germany.
  • Caudell J; Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
  • Corry J; Department Radiation Oncology Genesiscare, St Vincent's Hospital, Melbourne, Australia.
  • Corvo R; Department of Radiation Oncology, Ospedale Policlinico San Martino and University, Genoa, Italy.
  • Evans M; Department of Clinical Oncology, Velindre University NHS Trust, Cardiff, Wales, UK.
  • Garden AS; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Giralt J; Department of Radiation Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
  • Gregoire V; Department of Radiation Oncology, Centre Leon Berard, Lyon, France.
  • Harari PM; Department of Human Oncology, University of Wisconsin, Madison, Wisconsin.
  • Harrington K; Division of Radiotherapy and Imaging, Institute for Cancer Research, London, UK.
  • Hitchcock YJ; Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah.
  • Johansen J; Department of Oncology, Odense University Hospital, Department of Oncology, Denmark.
  • Kaanders J; Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands.
  • Koyfman S; Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
  • Langendijk JA; Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
  • Le QT; Department of Radiation Oncology, Stanford University, Palo Alto, California.
  • Lee N; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
  • Margalit D; Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
  • Mierzwa M; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  • Porceddu S; Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.
  • Soong YL; Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.
  • Sun Y; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China.
  • Thariat J; Department of Radiation Oncology, Centre François Baclesse, University of Normandy, Caen, France.
  • Waldron J; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
  • Yom SS; Department of Radiation Oncology, University of California San Francisco, San Francisco, California. Electronic address: sue.yom@ucsf.edu.
Int J Radiat Oncol Biol Phys ; 107(4): 618-627, 2020 07 15.
Article in English | MEDLINE | ID: covidwho-275257
ABSTRACT

PURPOSE:

Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff. METHODS AND MATERIALS A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases.

RESULTS:

In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care.

CONCLUSIONS:

This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Societies, Medical / Practice Guidelines as Topic / Coronavirus Infections / Consensus / Pandemics / Head and Neck Neoplasms / Medical Oncology Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research Topics: Long Covid Limits: Humans Language: English Journal: Int J Radiat Oncol Biol Phys Year: 2020 Document Type: Article Affiliation country: J.ijrobp.2020.04.016

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Societies, Medical / Practice Guidelines as Topic / Coronavirus Infections / Consensus / Pandemics / Head and Neck Neoplasms / Medical Oncology Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research Topics: Long Covid Limits: Humans Language: English Journal: Int J Radiat Oncol Biol Phys Year: 2020 Document Type: Article Affiliation country: J.ijrobp.2020.04.016