Early Appearance of Coronavirus Disease 2019 Associated Pulmonary Infiltrates During Daily Radiotherapy Imaging for Lung Cancer

Suppli, Morten Hiul; Blanck, Steen Riisgaard de; Elgaard, Tenna; Pøhl, Mette

doi:10.1016/j.jtho.2020.04.004

Cited by 27 publications

(28 citation statements)

References 3 publications

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“…However, the development of new infiltrates during radiotherapy was exhibited in a case report to precede COVID-19 symptoms and confirmed infection by 3 days. 71 Radiation oncologists can review daily radiotherapy imaging to ascertain if any new infiltrates develop and this may prove to be useful for early detection.…”

Section: Overall Treatment Of Patients With Lung Cancermentioning

confidence: 99%

Treatment Guidance for Patients With Lung Cancer During the Coronavirus 2019 Pandemic

Dingemans

Soo

Jazieh

et al. 2020

Journal of Thoracic Oncology

103

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The global coronavirus disease 2019 pandemic continues to escalate at a rapid pace inundating medical facilities and creating substantial challenges globally. The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer seems to be higher, especially as they are more likely to present with an immunocompromised condition, either from cancer itself or from the treatments they receive. A major consideration in the delivery of cancer care during the pandemic is to balance the risk of patient exposure and infection with the need to provide effective cancer treatment. Many aspects of the SARS-CoV-2 infection currently remain poorly characterized and even less is known about the course of infection in the context of a patient with cancer. As SARS-CoV-2 is highly contagious, the risk of infection directly affects the cancer patient being treated, other cancer patients in close proximity, and health care providers. Infection at any level for patients or providers can cause considerable disruption to even the most effective treatment plans. Lung cancer patients, especially those with reduced lung function and cardiopulmonary comorbidities are more likely to have increased risk and mortality from coronavirus disease 2019 as one of its common manifestations is as an acute respiratory illness. The purpose of this manuscript is to present a practical multidisciplinary and international overview to assist in treatment for lung cancer patients during this pandemic, with the caveat that evidence is lacking in many areas. It is expected that firmer recommendations can be developed as more evidence becomes available.

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Section: Overall Treatment Of Patients With Lung Cancermentioning

confidence: 99%

Treatment Guidance for Patients With Lung Cancer During the Coronavirus 2019 Pandemic

Dingemans

Soo

Jazieh

et al. 2020

Journal of Thoracic Oncology

103

View full text Add to dashboard Cite

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“…In addition, daily image guidance using cone-beam CT may help assess the development of infiltrates in patients who are asymptomatic. 61 If there is a preference to deliver concurrent chemoradiation, then induction chemotherapy may be considered to delay the time when patients need to come in for daily chemoradiotherapy treatments. Results from randomized phase II and III trials support such an approach after having compared chemoradiotherapy with and without induction chemotherapy, which revealed similar survival rates.…”

Section: Nonoperative Managementmentioning

confidence: 99%

Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic

Kumar

Chmura

Robinson

et al. 2020

Journal of Thoracic Oncology

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The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (LA-NSCLC) may require treatment in locations where resources are limited, and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The overarching goals of these approaches are the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome-coronavirus-2, (3) attenuate the immunocompromising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with definitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of patient factors and clinical resources. Whenever radiation therapy

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“…Asymptomatic infected patients pose a potential risk of spreading the virus without being noticed and which is a great challenge in RT clinics. Most recently, there have been case reports from the US and Europe [47] that new ground glass opacities were caught on the images obtained by CT on rail and cone beam CT (CBCT) for IGRT delivery of lung stereotactic ablative radiotherapy (SABR). Those patients were later all tested positive for COVID-19 even though they were totally asymptomatic.…”

Section: Igrtmentioning

confidence: 99%

Optimizing lung cancer radiation treatment worldwide in COVID-19 outbreak

et al. 2020

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COVID-19 has spread around the planet, sending billions of people into lockdown as health services struggle to cope. Meanwhile in Asia, where the disease began, the spread continues, in China it seems for now to have passed its peak. Italy, Spain, France, UK, and the US have been the countries more affected in terms of deaths. The coronavirus is more dangerous to the elderly and those with certain pre-existing medical conditions which is precisely the profile of lung cancer patients. Essential cancer services should be delivered but all steps should be taken to protect patients and the health workforce from infection with COVID-19. This presents a major challenge to radiotherapy (RT) departments worldwide. An international panel with expertise in the management of lung cancer in high-volume comprehensive centres has come together to share its experience on COVID-19 preparedness to deliver optimal care in such exceptional circumstances. A comprehensive systematic review of the literature through a PubMed search was undertaken. Twelve recommendations including, among others, the consideration of shorter courses, delays, and the omission of RT for lung cancer are proposed by the panel. In summary, we recommend the screening of every single person accessing the treatment room, the consideration of hypofractionation and to delay postoperative RT for non-small cell lung cancer, to avoid twice-daily treatments and delay or deliver prophylactic cranial irradiation during radio(chemo)therapy for limited-stage small cell lung cancer, review image guided RT images for suspicious image findings, and the use of single-fraction RT for the palliative treatment of stage IV lung cancer patients. Given that lung cancer is one of the most common and severe pathologies in radiation oncology departments, the following recommendations require particularly urgent consideration. The decision-making paths strongly depend on locally available resources, and a tailored approach should be used to attend lung cancer patients during this pandemic.

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Early Appearance of Coronavirus Disease 2019 Associated Pulmonary Infiltrates During Daily Radiotherapy Imaging for Lung Cancer

Cited by 27 publications

References 3 publications

Treatment Guidance for Patients With Lung Cancer During the Coronavirus 2019 Pandemic

Treatment Guidance for Patients With Lung Cancer During the Coronavirus 2019 Pandemic

Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic

Optimizing lung cancer radiation treatment worldwide in COVID-19 outbreak

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