BackgroundThe COVID-19 has caused significant mortality and morbidity across the globe. Patients with cancer are especially vulnerable given their immunocompromised state. We aimed to determine the proportion of COVID-19 patients with cancer, their severity and mortality outcomes through a systematic review and meta-analysis (MA).MethodsSystematic review was performed through online databases, PubMed, Medline and Google Scholar, with keywords listed in the Methods section (1 November 2019–31 December 2020). Studies with clinical outcomes of at least 10 COVID-19 patients and at least one with a diagnosis of cancer were included. The studies for MA were assessed with PRISMA guidelines and appraised with Newcastle-Ottawa Scale. The data were pooled using a random-effects model using STATA software. The main outcomes were planned before data collection, including proportion of patients with cancer among COVID-19 populations, relative risk (RR) of severe outcomes and death of patients with cancer compared with general COVID-19 patients.ResultsWe identified 57 case series (63 413 patients), with 230 patients with cancer with individual patient data (IPD). We found that the pooled proportion of cancer among COVID-19 patients was 0.04 (95% CI 0.03 to 0.05, I2=97.69%, p<0.001). The pooled RR of death was 1.44 (95% CI 1.19 to 1.76) between patients with cancer and the general population with COVID-19 infection. The pooled RR of severe outcome was 1.49 (95% CI 1.18 to 1.87) between cancer and general COVID-19 patients. The presence of lung cancer and stage IV cancer did not result in significantly increased RR of severe outcome. Among the available IPD, only age and gender were associated with severe outcomes.ConclusionPatients with cancer were at a higher risk of severe and death outcomes from COVID-19 infection as compared with general COVID-19 populations. Limitations of this study include publication bias. A collaborative effort is required for a more complete database.

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The role of stereotactic body radiotherapy (SBRT) in early stage medically operable non‐small cell lung cancer is currently under debate. SBRT's advantage is its ability to provide high radiotherapy doses to a tumor in a short timeframe, without the risk of postoperative complications and mortality. Currently, in part due to limited prospective data comparing both treatments, international guidelines continue to recommend surgical resection as the gold standard for medically operable patients. However, not all patients possess uniform characteristics, and there is some evidence that certain subgroups of patients would benefit more from one form of treatment ‐ SBRT or surgery ‐ than the other. The aim of this review is to provide a brief summary of the evidence comparing SBRT to surgery, followed by a deeper discussion of the subgroups of patients who would benefit most from surgery: those with large tumors, centrally located tumors, increased risk of occult nodal metastases, increased risk of toxicity from radiotherapy and radioresistant histological tumor subtypes. Meanwhile, patients who could benefit most from SBRT might include elderly patients, those with reduced lung function or cardiac comorbidities, those with synchronous lung nodules, and those with specific tumor mutational status. We hope that this review will aid in the clinical decision‐making process regarding patient selection for either treatment.

PurposeIn radical radiotherapy for cervical cancer, high-dose-rate (HDR) brachytherapy is commonly used after external beam radiation therapy (EBRT) to deliver a cumulative EQD2 of 80 to 90 Gy to the primary tumor. However, there is less certainty regarding brachytherapy dose contribution to the pelvic lymph nodes. This poses a challenge as to how high a preceding EBRT dose should be prescribed to gross nodal disease, in order to achieve a cumulative tumoricidal effect. Hence, this study aims to quantify brachytherapy dose contribution to individual pelvic nodal groups, using computed tomography (CT) planning with the Manchester system.Material and methodsThis is a single institution retrospective dosimetric study. CT planning datasets from 40 patients who received EBRT followed by intracavitary HDR brachytherapy (5 or 6 Gy fractions) were retrieved. The external iliac (EI), internal iliac (II), and obturator (OB) lymph node groups were contoured on each CT dataset. Applying the initial brachytherapy plan, mean doses to each nodal group were calculated for every patient, and averaged across the respective (5 or 6 Gy) study populations.ResultsWith a brachytherapy dose of 5 Gy to Manchester point A, the mean absolute doses received by the EI, II, and OB groups were 0.79, 1.12, and 1.34 Gy respectively, corresponding to EQD2s (α/β = 10) of 0.71, 1.04, and 1.27 Gy respectively. With a brachytherapy dose of 6 Gy, the mean absolute doses received by the EI, II, and OB groups were 1.16, 1.56, and 1.80 Gy respectively, corresponding to EQD2s of 1.08, 1.49, and 1.77 Gy, respectively.ConclusionsOur study demonstrates that pelvic lymph nodes receive substantial dose contributions from HDR brachytherapy in cervical cancer. This should be taken into account by the radiation oncologist during EBRT planning, and adequate external beam boost doses calculated to achieve cumulative tumoricidal doses to pelvic nodal disease.

The aim of this retrospective national cohort study is to assess the association between various radiation heart dosimetric parameters (RHDPs), acute myocardial infarct (AMI) and overall survival (OS) outcomes in non-small cell lung cancer (NSCLC) patients treated with post-operative thoracic radiotherapy (PORT) using contemporary radiation techniques.We identified patients with stage I to III NSCLC treated with PORT at the 2 national cancer institutions from 2007 to 2014. We linked their electronic medical records to the national AMI and death registries. Univariable Cox regression was performed to assess the association between various RHDPs, AMI, and OS.We included 43 eligible patients with median follow-up of 36.6 months. Median age was 64 years. Majority of the patients had pathological stage III disease (72%). Median prescription dose was 60Gy. Median mean heart dose (MHD) was 9.4Gy. There were no AMI events. The 5-year OS was 34%. Univariable Cox regression showed that age was significantly associated with OS (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.10; P = .008). Radiation heart doses, including MHD, volume of heart receiving at least 5, 25, 30, 40, 50Gy and dose to 30% of heart volume, were not significantly associated with OS.There is insufficient evidence to conclude that RHDPs are associated with OS for patients with NSCLC treated with PORT in this study. Studies with larger sample size and longer term follow-up are needed to assess AMI outcome.