Ying Xiaofang, Bi Jianping, Ding Yi, Wei Xueyan, Wei Wei, Xin Fang, Xiao Chuangying, Hu Desheng, Verma Vivek, Han Guang
Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Oncol. 2021 Nov 19;11:754838. doi: 10.3389/fonc.2021.754838. eCollection 2021.
This retrospective observational study examined patients who experienced radiotherapy (RT) interruption during the Wuhan lockdown for the novel coronavirus disease 2019 (COVID-19) pandemic.
The data of all patients whose RT was interrupted during the Wuhan lockdown from January 23 to April 8, 2020 were collected. Patient-, cancer-, and treatment-related characteristics were analyzed, along with interruption time, disease progression type, and survival status. The methods employed in order to compensate for RT interruption were also described.
There were altogether 129 cancer patients whose RT was interrupted. Nineteen (14.7%) patients experienced a total interruption time of at most 7 days; the interruption time was 8-14 days for 27 (20.9%) patients, and 15 or more days for 47 (36.4%) patients. The remaining 36 (27.9%) patients did not come back to our hospital for further RT. We first describe our experience with re-immobilization and/or re-planning (n = 17) as well as dose compensation/adjustment. Of the 40 definitive radiotherapy patients, 37 had squamous cell carcinoma of nasopharyngeal, lung, or cervical origin. Most patients (85/93, 91.4%) were followed up for more than one year. Among the 40 patients who received definitive radiotherapy, nine patients experienced disease progression and five patients died. Three of the seven (42.9%) patients who did not finish radiotherapy after interruption died, as compared to only two of the 33 (6.1%) patients who completed radiotherapy. EQD2 (equivalent dose in 2 Gy fractions) at the time point of RT interruption was calculated. Five of the six patients (83.3%) who received EQD2 ≤10 Gy suffered from disease progression, compared with four of the 34 (11.8%) patients who received EQD2 >10 Gy. For the seven definitive radiotherapy cases who did not finish radiotherapy, three received systemic anti-cancer treatments and three died (all of whom did not receive further systemic therapies).
This study provides the longest follow-up for the outcomes of RT interruption during COVID-19 pandemic to date. It cannot imply causation but implies that completing RT is important, along with the utility of having patients remain on systemic therapies if RT is to be interrupted.
这项回顾性观察性研究对在2019年新型冠状病毒病（COVID-19）疫情武汉封城期间经历放疗中断的患者进行了调查。
收集了2020年1月23日至4月8日武汉封城期间所有放疗中断患者的数据。分析了患者、癌症及治疗相关特征，以及中断时间、疾病进展类型和生存状况。还描述了为弥补放疗中断所采用的方法。
共有129例癌症患者放疗中断。19例（14.7%）患者的总中断时间最多为7天；27例（20.9%）患者的中断时间为8 - 14天，47例（36.4%）患者的中断时间为15天或更长。其余36例（27.9%）患者未返回我院继续放疗。我们首先描述了重新固定和/或重新计划（n = 17）以及剂量补偿/调整方面的经验。在40例根治性放疗患者中，37例为鼻咽、肺或宫颈来源的鳞状细胞癌。大多数患者（85/93，91.4%）接受了超过一年的随访。在40例接受根治性放疗的患者中，9例出现疾病进展，5例死亡。中断放疗后未完成放疗的7例患者中有3例（42.9%）死亡，而完成放疗的33例患者中仅有2例（6.1%）死亡。计算了放疗中断时间点的等效剂量（2 Gy分割剂量下的等效剂量，EQD2）。接受EQD2≤10 Gy的6例患者中有5例（83.3%）出现疾病进展，而接受EQD2>10 Gy的34例患者中有4例（11.8%）出现疾病进展。对于7例未完成放疗的根治性放疗病例，3例接受了全身抗癌治疗，3例死亡（均未接受进一步的全身治疗）。
本研究提供了迄今为止对COVID-19疫情期间放疗中断结局最长时间的随访。这并不意味着因果关系，但表明完成放疗很重要，同时也表明如果放疗要中断，让患者继续接受全身治疗是有作用的。
