Parikh Shreel, Zhang Yingting, Sherwani Zohaib, Kumar Ritesh, Ohri Nisha, Jan Imraan, Vergalasova Irina, Jabbour Salma, Hathout Lara
Department of Radiation Oncology, Rutgers Cancer Institute, Robert Wood Johnson Medical School, New Brunswick, NJ.
Robert Wood Johnson Library of the Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ.
Brachytherapy. 2024 Mar-Apr;23(2):141-148. doi: 10.1016/j.brachy.2023.11.002. Epub 2024 Feb 1.
PURPOSE/OBJECTIVE(S): To assess the impact of the COVID-19 pandemic on the use of brachytherapy in patients with gynecologic and prostate cancers including treatment delays, increased burden of mortality, and associated clinical outcomes.
MATERIALS/METHODS: A comprehensive search of PubMed, Cochrane Library, CINAHL, Scopus, and Web of Science was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for studies published through September 2023 using MeSH terms and keywords related to "COVID and brachytherapy." Inclusion criteria included all studies reporting on the impact of COVID-19 on treatment delay, treatment omission, recurrence rates, and clinical outcomes in patients requiring brachytherapy for prostate or gynecologic cancers from December 2019 to September 2023. Data were extracted by two independent reviewers (LH, IV).
Of the 292 screened records, 10 studies (9 retrospective, 1 prospective single-arm exploratory noninferiority) were included. Hypofractioned regimens were the preferred approach in radiation treatment (RT) centers, with 6 of 10 studies noting shift towards hypofractionation. For cervical cancer, intracavitary brachytherapy was limited to 3-4 fractions, reducing personnel and patient exposure. Treatment delays influenced by COVID-19 ranged between 19% and 53% and treatment omissions ranged between 2% and 28%. These disruptions arose from factors such as patient fear of contracting COVID-19, COVID-19 infection, barriers to accessing care, and operating room closures. Three studies reported on a single-application (SA) rather than a multiple application (MA) approach for cervical cancer. They reported excellent local control, shorter overall treatment time at the expense of higher grade ≥2 vaginal, genitourinary, and gastrointestinal events. For cervical cancer patients, overall treatment time (OTT) was significantly impacted by COVID-19 as reported by 2 studies from India. OTT > 60 days occurred in 40-53% of patients.
This is the first systematic review to assess the impact of the COVID-19 pandemic on brachytherapy in patients with gynecologic and prostate cancers. Although many expert consensus recommendations have been published during the pandemic regarding radiation therapy, few studies evaluated its clinical impact on brachytherapy delivery and patient outcomes. The COVID-19 pandemic resulted in treatment delays, omissions in brachytherapy, and further adoption of hypofractionated regimens. Early results demonstrate that despite increased toxicities, local control rates with hypofractionated treatment are similar to standard fractionation. The impact of the pandemic on gynecologic and prostate cancers is yet to be determined as well as the long-term outcomes on patients treated during the lockdown period.
评估2019年冠状病毒病（COVID-19）大流行对妇科和前列腺癌患者近距离放射治疗使用的影响，包括治疗延迟、死亡率负担增加以及相关临床结果。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对PubMed、Cochrane图书馆、护理学与健康领域数据库（CINAHL）、Scopus和科学引文索引（Web of Science）进行全面检索。使用与“COVID和近距离放射治疗”相关的医学主题词（MeSH）和关键词，检索截至2023年9月发表的研究。纳入标准包括2019年12月至2023年9月期间所有报告COVID-19对前列腺癌或妇科癌症患者近距离放射治疗延迟、治疗遗漏、复发率和临床结果影响的研究。数据由两名独立评审员（LH、IV）提取。
在筛选的292条记录中，纳入了10项研究（9项回顾性研究，1项前瞻性单臂探索性非劣效性研究）。在放射治疗（RT）中心，低分割方案是首选方法，10项研究中有6项指出向低分割治疗转变。对于宫颈癌，腔内近距离放射治疗限制为3 - 4次分割，以减少人员和患者暴露。受COVID-19影响的治疗延迟在19%至53%之间，治疗遗漏在2%至28%之间。这些干扰源于患者对感染COVID-19的恐惧、COVID-19感染、获得医疗服务的障碍以及手术室关闭等因素。三项研究报告了宫颈癌的单次应用（SA）而非多次应用（MA）方法。他们报告了良好的局部控制，总体治疗时间较短，但代价是≥2级阴道、泌尿生殖系统和胃肠道事件发生率较高。印度的两项研究报告称，COVID-19对宫颈癌患者的总体治疗时间（OTT）有显著影响。40%至53%的患者OTT>60天。
这是第一项评估COVID-19大流行对妇科和前列腺癌患者近距离放射治疗影响的系统评价。尽管在大流行期间已经发布了许多关于放射治疗的专家共识建议，但很少有研究评估其对近距离放射治疗实施和患者结果的临床影响。COVID-19大流行导致了治疗延迟、近距离放射治疗的遗漏以及低分割方案的进一步采用。早期结果表明，尽管毒性增加，但低分割治疗的局部控制率与标准分割相似。大流行对妇科和前列腺癌的影响以及封锁期间接受治疗患者的长期结果尚待确定。
