Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19) has resulted in a global health crisis. Prior to the arrival of this viral pandemic, the world was already plagued with a significant burden of cardiovascular disease. With the introduction of the novel virus, the world now faces a double jeapordy. Early reports have suggested an increased risk of death in individuals with underlying cardio-metabolic disorders. The exact effects of COVID-19 on the cardiovascular system are not well determined, however lessons from prior viral epidemics suggest that such infections can trigger acute coronary syndromes, arrhythmias and heart failure via direct and indirect mechanisms. In this article, we aimed to discuss the effects and potential underlying mechanisms of COVID -19 as well as potential implications of treatments targeted against this virus on the cardiovascular system.

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Purpose/objectives: To report early adverse events and patient-reported outcomes (PROs) of 3fraction intracavitary catheter-based partial breast brachytherapy (ICBB). Materials/methods: Eligible women ≥ 50 years of age with ≤2.5 cm, lymph node negative invasive or in-situ breast cancer underwent breast conserving surgery and placement of a brachytherapy applicator. ICBB was initiated on the second weekday after surgery and prescribed to 21 Gy in three, once daily, fractions. Common Terminology Criteria for Adverse Events (CTCAE) v 4.0, 10-point Linear Analog Scales Assessment, PROs version of the CTCAE (PRO-CTCAE), and Harvard Breast Cosmesis Scale were utilized for provider and patient-reported assessments. Results: 73 women were treated for invasive (79%) or in-situ (21%) breast cancer. The median time to completion of surgery and radiotherapy was 6 days. After 14 months median follow-up, two patients (3%) had developed breast infections that resolved with oral antibiotics. There was no other treatment-associated adverse event ≥ grade 2. The grade 1 seroma rate at 3 months was 20% which dropped to 8% at 12 months; none required intervention. At 12 months, 91% of patients reported an overall QoL score as ≥ 8 out of 10 and patient-reported cosmesis was good or excellent in 95%. All patients are alive without relapse at the last follow-up. Conclusions: 3-fraction ICBB is associated with low rates of early provider and patient reported adverse events and compares favorably with early outcomes of more protracted ICBB regimens

Background and purposeTo report dosimetry and early adverse effects, aesthetic, and patient-reported outcomes of a prospective study of 3-fraction pencil-beam scanning (PBS) proton accelerated partial irradiation (APBI).Materials and methodsEligibility included women age ≥ 50 years with estrogen receptor positive (ER+), sentinel lymph node negative invasive or in-situ breast cancer measuring ≤2.5 cm. The prescription was 21.9 Gy (RBE 1.1) in 3 daily fractions to the post-operative tumor bed with a 1 cm expansion. Toxicities were collected using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, 10-point Linear Analog Scale Assessment, Patient-Reported Outcomes Version of the CTCAE, and the Harvard Breast Cosmesis Scale.ResultsSeventy-six women were treated between 2015 and 2017. The median breast volume receiving 50% of prescription or more was 28%. Median mean heart, mean ipsilateral lung, and maximum skin dose were 0 Gy, 0.1 Gy, and 20.6 Gy, respectively. With a median follow-up of 12 months, no treatment-related toxicity grade ≥ 2 has been observed. Most common grade 1 adverse events were dermatitis (68%) and skin hyperpigmentation (18%). At 12 months, the only persistent toxicities were one patient with grade 1 breast edema and one patient with a grade 1 seroma. 90% of patients reported quality of life as ≥7 out of 10 (0 indicating “as bad as it can be” and 10 indicating “as good as it can be”) and 98% of patients reported excellent or good cosmesis.Conclusion3-fraction PBS proton APBI is well tolerated with low rates of physician and patient reported early adverse effects. Follow-up is ongoing to assess late toxicities and disease control outcomes. Further investigation of this novel adjuvant treatment strategy is warranted.