University of Manchester, Manchester, UK.
University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
Clin Oncol (R Coll Radiol). 2023 Oct;35(10):e593-e600. doi: 10.1016/j.clon.2023.07.005. Epub 2023 Jul 22.
Previous work found that during the first wave of the COVID-19 pandemic, 34% of patients with lung cancer treated with curative-intent radiotherapy in the UK had a change to their centre's usual standard of care treatment (Banfill et al. Clin Oncol 2022;34:19-27). We present the impact of these changes on patient outcomes.
The COVID-RT Lung database was a prospective multicentre UK cohort study including patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between April and October 2020. Data were collected on patient demographics, radiotherapy and systemic treatments, toxicity, relapse and death. Multivariable Cox and logistic regression were used to assess the impact of having a change to radiotherapy on survival, distant relapse and grade ≥3 acute toxicity. The impact of omitting chemotherapy on survival and relapse was assessed using multivariable Cox regression.
Patient and follow-up forms were available for 1280 patients. Seven hundred and sixty-five (59.8%) patients were aged over 70 years and 603 (47.1%) were female. The median follow-up was 213 days (119, 376). Patients with stage I-II non-small cell lung cancer (NSCLC) who had a change to their radiotherapy had no significant increase in distant relapse (P = 0.859) or death (P = 0.884); however, they did have increased odds of grade ≥3 acute toxicity (P = 0.0348). Patients with stage III NSCLC who had a change to their radiotherapy had no significant increase in distant relapse (P = 0.216) or death (P = 0.789); however, they did have increased odds of grade ≥3 acute toxicity (P < 0.001). Patients with stage III NSCLC who had their chemotherapy omitted had no significant increase in distant relapse (P = 0.0827) or death (P = 0.0661).
This study suggests that changes to radiotherapy and chemotherapy made in response to the COVID-19 pandemic did not significantly affect distant relapse or survival. Changes to radiotherapy, namely increased hypofractionation, led to increased odds of grade ≥3 acute toxicity. These results are important, as hypofractionated treatments can help to reduce hospital attendances in the context of potential future emergency situations.
先前的研究发现，在 COVID-19 大流行的第一波期间，英国接受根治性放疗的肺癌患者中有 34%的患者的中心常规治疗标准发生了改变（Banfill 等人，临床肿瘤学 2022；34:19-27）。我们介绍了这些变化对患者结局的影响。
COVID-RT 肺数据库是一项前瞻性多中心英国队列研究，包括 2020 年 4 月至 10 月期间因接受根治性放疗而转诊或接受根治性放疗的 I-III 期肺癌患者。收集了患者的人口统计学、放疗和系统治疗、毒性、复发和死亡数据。多变量 Cox 和逻辑回归用于评估放疗改变对生存、远处复发和≥3 级急性毒性的影响。使用多变量 Cox 回归评估省略化疗对生存和复发的影响。
1280 名患者的患者和随访表格可用。765 名（59.8%）患者年龄超过 70 岁，603 名（47.1%）为女性。中位随访时间为 213 天（119，376）。接受放疗改变的 I-II 期非小细胞肺癌（NSCLC）患者远处复发（P = 0.859）或死亡（P = 0.884）无显著增加；然而，他们确实有更高的≥3 级急性毒性的几率（P = 0.0348）。接受放疗改变的 III 期 NSCLC 患者远处复发（P = 0.216）或死亡（P = 0.789）无显著增加；然而，他们确实有更高的≥3 级急性毒性的几率（P < 0.001）。省略化疗的 III 期 NSCLC 患者远处复发（P = 0.0827）或死亡（P = 0.0661）无显著增加。
本研究表明，针对 COVID-19 大流行而做出的放疗和化疗改变并未显著影响远处复发或生存。放疗的改变，即增加分割次数，导致≥3 级急性毒性的几率增加。这些结果很重要，因为在潜在的未来紧急情况下，缩短分割的治疗有助于减少住院就诊次数。
