Department of Radiation Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France; Radiothérapie Moléculaire et Innovation Thérapeutique, Paris-Saclay University, Gustave Roussy, Villejuif, France.
Department of Radiation Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2021 Jul 15;110(4):947-956. doi: 10.1016/j.ijrobp.2021.02.022. Epub 2021 Feb 17.
Patients with cancer are presumed to be more vulnerable to COVID-19. We evaluated a screening strategy combining chest computed tomography (CT) and reverse-transcription polymerase chain reaction (RT-PCR) for patients treated with radiation therapy at our cancer center located in a COVID-19 French hotspot during the first wave of the pandemic.
Chest CT images were proposed during radiation therapy CT simulation. Images were reviewed by an expert radiologist according to the COVID-19 Reporting and Data System classification. Nasal swabs with RT-PCR assay were initially proposed in cases of suspicious imaging or clinical context and were eventually integrated into the systematic screening. A dedicated radiation therapy workflow was proposed for COVID-19 patients to limit the risk of contamination.
From March 18, 2020 to May 1, 2020, 480 patients were screened by chest CT, and 313 patients had both chest CT and RT-PCR (65%). The cumulative incidence of COVID-19 was 5.4% (95% confidence interval [CI], 3.6-7.8; 26 of 480 patients). Diagnosis of COVID-19 was made before radiation therapy for 22 patients (84.6%) and during RT for 4 patients (15.3%). Chest CT directly aided the diagnosis of 7 cases in which the initial RT-PCR was negative or not feasible, out of a total of 480 patients (1.5%) and 517 chest CT acquisitions. Four patients with COVID-19 at the time of the chest CT screening had a false negative CT. Sensitivity and specificity of chest CT screening in patients with both RT-PCR and chest CT testing were estimated at 0.82 (95% CI, 0.60-0.95) and 0.98 (95% CI, 0.96-0.99), respectively. Adaptation of the radiation therapy treatment was made for all patients, with 7 postponed treatments (median: 5 days; interquartile range, 1.5-14.8).
The benefit of systematic use of chest CT screening during CT simulation for patients undergoing radiation therapy during the COVID-19 pandemic seemed limited.
患有癌症的患者被认为更容易感染 COVID-19。我们评估了一种筛查策略，该策略结合胸部计算机断层扫描（CT）和逆转录聚合酶链反应（RT-PCR），用于在 COVID-19 法国热点地区的癌症中心接受放射治疗的患者。
在放射治疗 CT 模拟期间提出胸部 CT 图像。根据 COVID-19 报告和数据系统分类，由一名专家放射科医生对图像进行审查。最初在可疑影像学或临床情况下提出鼻咽拭子 RT-PCR 检测，最终纳入系统筛查。为 COVID-19 患者提出了专门的放射治疗工作流程，以降低污染风险。
从 2020 年 3 月 18 日至 2020 年 5 月 1 日，对 480 名患者进行了胸部 CT 筛查，313 名患者同时进行了胸部 CT 和 RT-PCR（65%）。COVID-19 的累积发病率为 5.4%（95%置信区间[CI]，3.6-7.8；480 名患者中有 26 例）。22 例（84.6%）患者在放射治疗前和 4 例（15.3%）患者在 RT 期间确诊 COVID-19。480 例患者中共有 7 例（1.5%）和 517 次胸部 CT 采集的初始 RT-PCR 为阴性或不可行，胸部 CT 直接辅助诊断。同时进行 RT-PCR 和胸部 CT 检测的患者中，胸部 CT 筛查的敏感性和特异性估计分别为 0.82（95%CI，0.60-0.95）和 0.98（95%CI，0.96-0.99）。对所有患者都进行了放射治疗的调整，有 7 次治疗推迟（中位数：5 天；四分位距，1.5-14.8）。
在 COVID-19 大流行期间，对接受放射治疗的患者在 CT 模拟期间系统使用胸部 CT 筛查的益处似乎有限。
