Vasiliadou Ifigenia, Noble David, Hartley Andrew, Moleron Rafael, Sanghera Paul, Urbano Teresa Guerrero, Schipani Stefano, Gujral Dorothy, Foran Bernie, Bhide Shree, Haridass Anoop, Nathan Kannon, Michaelidou Andriana, Sen Mehmet, Geropantas Konstantinos, Joseph Mano, O'Toole Lorcan, Griffin Matthew, Pettit Laura, Chambers Jonathan, Jankowska Petra, De Winton Emma, Goranova Rebecca, Singh Niveditha, Shah Ketan, Kong Conceptualisation Anthony
Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom.
Edinburgh Cancer Centre, Edinburgh, United Kingdom.
Clin Transl Radiat Oncol. 2021 Sep;30:50-59. doi: 10.1016/j.ctro.2021.06.002. Epub 2021 Jun 30.
The onset of the COVID-19 pandemic necessitated rapid changes to the practice of head and neck oncology in UK. There was a delay between the onset of the pandemic and the release of guidelines from cancer societies and networks, leading to a variable response of individual centres. This survey was conducted to assess the pre-Covid-19 pandemic standard of practice for head and neck oncology patients and the treatment modifications introduced during the first wave of the pandemic in UK.
The UK National Cancer Research Institute (NCRI) Head and Neck Clinical Studies Group initiated a multi-centre survey using questionnaire to investigate the effect on feeding tube practice, radiotherapy (RT) fractionation and volumes, use of chemotherapy in the neo-adjuvant, concurrent and palliative setting, the use of immunotherapy in the palliative setting, access to radiology and histopathology services, and availability of surgical procedures.
30 centres were approached across UK; 23 (76.7%) centres responded and were included in the survey. There were differences in the standard practices in feeding tube policy, RT dose and fractionation as well as concurrent chemotherapy use. 21 (91%) participating centres had at least one treatment modification. 15 (65%) centres initiated a change in radical RT; changing to either a hypofractionation or acceleration schedule. For post-operative RT 10 centres (43.5%) changed to a hypofractionation schedule. 12 (52.2%) centres stopped neo-adjuvant chemotherapy for all patients; 13 (56.5%) centres followed selective omission of chemotherapy in concurrent chemo-radiotherapy patients, 17 (73.9%) centres changed first-line chemotherapy treatment to pembrolizumab (following NHS England's interim guidance) and 8 (34.8%) centres stopped the treatment early or offered delays for patients that have been already on systemic treatment. The majority of centres did not have significant changes associated with surgery, radiology, histopathology and dental screening.
There are variations in the standard of practice and treatment modifications for head and neck cancer patients during Covid-19 pandemic. A timely initiative is required to form a consensus on head and neck cancer management in the UK and other countries.
新冠疫情的爆发使得英国头颈肿瘤学的诊疗实践需要迅速改变。疫情爆发与癌症协会和网络发布指南之间存在延迟，导致各个中心的应对方式各不相同。本次调查旨在评估新冠疫情前英国头颈肿瘤患者的标准诊疗实践以及疫情第一波期间所采用的治疗调整措施。
英国国家癌症研究所（NCRI）头颈临床研究小组发起了一项多中心调查，通过问卷来研究对饲管使用、放疗分割和体积、新辅助、同步和姑息治疗中化疗的使用、姑息治疗中免疫治疗的使用、放射学和组织病理学服务的获取以及手术程序可用性的影响。
英国共有30个中心收到邀请；23个（76.7%）中心做出回应并被纳入调查。在饲管政策、放疗剂量和分割以及同步化疗使用方面的标准实践存在差异。21个（9%）参与调查的中心至少进行了一项治疗调整。15个（65%）中心开始改变根治性放疗；改为超分割或加速方案。对于术后放疗，10个中心（43.5%）改为超分割方案。12个（52.2%）中心停止了所有患者的新辅助化疗；13个（56.5%）中心在同步放化疗患者中选择性地省略化疗，17个（73.9%）中心将一线化疗治疗改为派姆单抗（遵循英国国民医疗服务体系英格兰地区的临时指南），8个（34.8%）中心提前停止治疗或为已经接受全身治疗的患者提供延迟治疗。大多数中心在手术、放射学、组织病理学和牙科筛查方面没有显著变化。
新冠疫情期间，头颈癌患者的诊疗实践标准和治疗调整存在差异。需要及时采取行动，就英国和其他国家的头颈癌管理达成共识。
