Allali S, Servois V, Beddok A, Fourquet A, Kirova Y
Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
Department of Radiology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
Cancer Radiother. 2022 Jun;26(4):577-584. doi: 10.1016/j.canrad.2021.10.011. Epub 2022 Feb 4.
The coronavirus disease 2019 (covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early and late toxicity in patients infected with covid-19 treated at the same time for early-stage breast cancer.
This is a monocentric prospective study of patients treated in our hospital between March and June 2020 who were diagnosed with covid-19 infection. The inclusion criteria were to be irradiated for early-stage breast cancer and to have a positive covid diagnosis on a polymerase chain reaction (PCR) test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. All of them needed 6 months follow-up clinic after the end of the radiotherapy with clinical examination, mammogram, as well as CT scan to evaluate the lung status. Radiotherapy consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment-related toxicity was graded according to the Common Toxicology Criteria for Adverse Events (version 4.03).
All 350 patients treated for early-stage breast cancer were studied. Of them, 16 presented clinical symptoms of covid-19 infection, and of them 12 had clinical, CT scan and PCR confirmation. This entire cohort of 12 patients with median age of 56years (range: 42-72 years) underwent their radiotherapy. During the radiotherapy, nine patients presented radiodermatitis: eight grade 1 (66%) and one grade 2 (8%). Two patients with lymph nodes irradiation presented grade 2 oesophagitis. Late toxicity was evaluated 6 months after the end of the radiotherapy, and there was no radiation or covid lung sequel on the CT scans. One patient presented covid-related dyspnoea, and two had fibrosis.
The half-year follow-up of prospective covid-19 cohort, treated for early-stage breast cancer demonstrated an acceptable toxicity profile with few low-grade adverse events. It seems that the covid-19 infection does not appear to increase the side effects of radiotherapy. Therefore radiotherapy should not be delayed.
由严重急性呼吸综合征冠状病毒2（Sars-Cov-2）引起的2019冠状病毒病（covid-19）引发了全球大流行。这场大流行促使当前的卫生系统进行重组，并重新思考医疗机构提供的护理服务。我们报告了同时接受早期乳腺癌治疗的covid-19感染患者的早期和晚期毒性反应。
这是一项单中心前瞻性研究，研究对象为2020年3月至6月在我院接受治疗且被诊断为covid-19感染的患者。纳入标准为患有早期乳腺癌且正在接受放疗，同时聚合酶链反应（PCR）检测和/或肺部计算机断层扫描（CT）扫描呈covid阳性和/或有提示性临床症状。所有患者在放疗结束后均需进行6个月的随访门诊，包括临床检查、乳房X光检查以及CT扫描以评估肺部状况。放疗包括对乳房或胸壁进行照射，可伴有或不伴有淋巴结照射，治疗方案根据大流行情况进行调整。治疗相关毒性根据《不良事件通用毒理学标准》（第4.03版）进行分级。
对所有350例接受早期乳腺癌治疗的患者进行了研究。其中，16例出现了covid-19感染的临床症状，其中12例通过临床、CT扫描和PCR检测得到确诊。这12例患者的中位年龄为56岁（范围：42 - 72岁），均接受了放疗。放疗期间，9例患者出现放射性皮炎：8例为1级（66%），1例为2级（8%）。2例接受淋巴结照射的患者出现2级食管炎。放疗结束6个月后评估晚期毒性，CT扫描未发现放射性或covid相关的肺部后遗症。1例患者出现与covid相关的呼吸困难，2例出现纤维化。
对接受早期乳腺癌治疗的covid-19前瞻性队列进行的半年随访显示，毒性反应可接受，低级别不良事件较少。似乎covid-19感染并未增加放疗的副作用。因此，放疗不应延迟。
