Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
Department of Radiation Oncology, LMU Klinikum, LMU Munich, Germany.
Int J Radiat Oncol Biol Phys. 2020 Jul 15;107(4):631-640. doi: 10.1016/j.ijrobp.2020.05.012.
The COVID-19 pandemic has caused radiotherapy resource pressures and led to increased risks for lung cancer patients and healthcare staff. An international group of experts in lung cancer radiotherapy established this practice recommendation pertaining to whether and how to adapt radiotherapy for lung cancer in the COVID-19 pandemic.
For this ESTRO & ASTRO endorsed project, 32 experts in lung cancer radiotherapy contributed to a modified Delphi consensus process. We assessed potential adaptations of radiotherapy in two pandemic scenarios. The first, an early pandemic scenario of risk mitigation, is characterized by an altered risk-benefit ratio of radiotherapy for lung cancer patients due to their increased susceptibility for severe COVID-19 infection, and minimization of patient travelling and exposure of radiotherapy staff. The second, a later pandemic scenario, is characterized by reduced radiotherapy resources requiring patient triage. Six common lung cancer cases were assessed for both scenarios: peripherally located stage I NSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radiotherapy and prophylactic cranial irradiation for limited stage SCLC and palliative thoracic radiotherapy for stage IV NSCLC.
In a risk-mitigation pandemic scenario, efforts should be made not to compromise the prognosis of lung cancer patients by departing from guideline-recommended radiotherapy practice. In that same scenario, postponement or interruption of radiotherapy treatment of COVID-19 positive patients is generally recommended to avoid exposure of cancer patients and staff to an increased risk of COVID-19 infection. In a severe pandemic scenario characterized by reduced resources, if patients must be triaged, important factors for triage include potential for cure, relative benefit of radiation, life expectancy, and performance status. Case-specific consensus recommendations regarding multimodality treatment strategies and fractionation of radiotherapy are provided.
This joint ESTRO-ASTRO practice recommendation established pragmatic and balanced consensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic.
COVID-19 大流行导致放疗资源压力增大，使肺癌患者和医护人员面临更大的风险。一个由肺癌放疗领域的国际专家组成的小组制定了本实践建议，旨在探讨在 COVID-19 大流行期间是否以及如何调整肺癌放疗。
作为这项 ESTRO 和 ASTRO 认可的项目，32 名肺癌放疗专家参与了改良 Delphi 共识过程。我们评估了在两种大流行情景下放疗的潜在调整。第一种是风险缓解的早期大流行情景，其特点是由于肺癌患者感染 COVID-19 严重感染的风险增加，以及尽量减少患者旅行和放疗工作人员暴露，放疗对肺癌患者的利弊比发生改变。第二种是放疗资源减少需要进行患者分类的后期大流行情景。针对这两种情况，我们评估了六种常见的肺癌病例：外周型 I 期 NSCLC、局部晚期 NSCLC、切除 pN2 NSCLC 后的术后放疗、胸放疗和局限期 SCLC 的预防性颅脑照射、以及 IV 期 NSCLC 的姑息性胸放疗。
在风险缓解大流行情景下，应努力避免因偏离指南推荐的放疗实践而影响肺癌患者的预后。在同一情景下，通常建议推迟或中断 COVID-19 阳性患者的放疗治疗，以避免癌症患者和工作人员面临 COVID-19 感染风险增加。在资源严重减少的严重大流行情景下，如果必须对患者进行分类，分类的重要因素包括治愈的可能性、放疗的相对益处、预期寿命和表现状态。还提供了针对多模态治疗策略和放疗分割的具体病例共识建议。
本 ESTRO-ASTRO 联合实践建议针对肺癌放疗的常见临床情景制定了务实且平衡的共识建议，以应对 COVID-19 大流行带来的挑战。
