The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK.
Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Physics, Clatterbridge Cancer Centre, Bebington, Wirral, UK.
Clin Oncol (R Coll Radiol). 2020 Aug;32(8):481-489. doi: 10.1016/j.clon.2020.05.001. Epub 2020 May 13.
Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic. Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.
接受以治愈为目的的肺部放射治疗的患者是感染 COVID-19 后出现严重并发症和死亡的高危人群。因此，迫切需要降低多次住院和抗癌治疗带来的风险。一种建议是考虑替代剂量分割方案或放射治疗技术。这也将增加适用于 I 期-III 期肺癌的可手术患者的放射治疗服务能力，这些患者可能在大流行期间无法进行手术。在这里，我们从 2020 年 3 月 20 日至 2020 年 3 月 30 日之间进行的文献检索以及英国中心公布和未公布的分次放疗方案的审计中，确定了肺癌中以治愈为目的的放射治疗方案的低分割方案。讨论了早期 NSCLC、III 期 NSCLC、早期和局部晚期 SCLC 的证据、实际考虑因素和局限性。我们建议与其他专业的肺部 MDT 成员讨论这份指导文件，以传播可能对放射治疗实践进行的改变，从而减轻胸外科等其他科室的压力。这也是知情同意过程的关键部分，以确保患者充分了解在 COVID-19 大流行期间接受癌症治疗的风险和获益，以及剂量分割减少带来的毒性的不确定性。此外，中心应记录所有偏离标准方案的情况，我们强烈敦促所有同事尽可能加入旨在记录 COVID-19 大流行对肺癌治疗和结果影响的国家/国际数据收集倡议（如 COVID-RT Lung）。
