Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: An ESTRO-ASTRO consensus statement Journal Article


Authors: Guckenberger, M.; Belka, C.; Bezjak, A.; Bradley, J.; Daly, M. E.; DeRuysscher, D.; Dziadziuszko, R.; Faivre-Finn, C.; Flentje, M.; Gore, E.; Higgins, K. A.; Iyengar, P.; Kavanagh, B. D.; Kumar, S.; Le Pechoux, C.; Lievens, Y.; Lindberg, K.; McDonald, F.; Ramella, S.; Rengan, R.; Ricardi, U.; Rimner, A.; Rodrigues, G. B.; Schild, S. E.; Senan, S.; Simone, C. B. 2nd; Slotman, B. J.; Stuschke, M.; Videtic, G.; Widder, J.; Yom, S. S.; Palma, D.
Article Title: Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: An ESTRO-ASTRO consensus statement
Abstract: Background: The COVID-19 pandemic has caused radiotherapy resource pressures and led to increased risks for lung cancer patients and healthcare staff. An international group of experts in lung cancer radiotherapy established this practice recommendation pertaining to whether and how to adapt radiotherapy for lung cancer in the COVID-19 pandemic. Methods: For this ESTRO & ASTRO endorsed project, 32 experts in lung cancer radiotherapy contributed to a modified Delphi consensus process. We assessed potential adaptations of radiotherapy in two pandemic scenarios. The first, an early pandemic scenario of risk mitigation, is characterized by an altered risk–benefit ratio of radiotherapy for lung cancer patients due to their increased susceptibility for severe COVID-19 infection, and minimization of patient travelling and exposure of radiotherapy staff. The second, a later pandemic scenario, is characterized by reduced radiotherapy resources requiring patient triage. Six common lung cancer cases were assessed for both scenarios: peripherally located stage I NSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radiotherapy and prophylactic cranial irradiation for limited stage SCLC and palliative thoracic radiotherapy for stage IV NSCLC. Results: In a risk-mitigation pandemic scenario, efforts should be made not to compromise the prognosis of lung cancer patients by departing from guideline-recommended radiotherapy practice. In that same scenario, postponement or interruption of radiotherapy treatment of COVID-19 positive patients is generally recommended to avoid exposure of cancer patients and staff to an increased risk of COVID-19 infection. In a severe pandemic scenario characterized by reduced resources, if patients must be triaged, important factors for triage include potential for cure, relative benefit of radiation, life expectancy, and performance status. Case-specific consensus recommendations regarding multimodality treatment strategies and fractionation of radiotherapy are provided. Conclusion: This joint ESTRO-ASTRO practice recommendation established pragmatic and balanced consensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic. © 2020 The Author(s)
Keywords: radiotherapy; diagnosis; biological organs; postoperative radiotherapy; diseases; performance status; risk perception; lung cancer radiotherapy; radiotherapy treatment; international group; life expectancies; prophylactic cranial irradiations; resource pressure
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 107
Issue: 4
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2020-07-15
Start Page: 631
End Page: 640
Language: English
DOI: 10.1016/j.ijrobp.2020.05.012
PROVIDER: scopus
PUBMED: 32589990
DOI/URL:
Notes: Article -- Export Date: 1 July 2020 -- Source: Scopus
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MSK Authors
  1. Andreas Rimner
    324 Rimner
  2. Charles Brian Simone
    15 Simone