Implications of COVID-19 pandemic on lung cancer management: A multidisciplinary perspective

Abstract

Treatment of patients with lung cancer during the current COVID-19 pandemic is challenging. Lung cancer is a heterogenous disease with a wide variety of therapeutic options. Oncologists have to determine the risks and benefits of modifying the treatment plans of patients especially in situation where the disease biology and treatment are complex. Health care visits carry a risk of transmission of SARS-CoV-2 and the similarities of COVID-19 symptoms and lung cancer manifestations represent a dominant problem. Efforts to modify treatment of lung cancer during the current pandemic have been adapted by many healthcare institutes to reduce exposure of lung cancer patients to SARS-CoV-2. We summarized the implications of COVID-19 pandemic on the management of lung cancer from the perspective of different specialties of thoracic oncology multidisciplinary team.

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

“… SCLC: - CRT for limited-stage - Palliative or ablative radiotherapy (SBRT) ( Omeroglu Simsek, 2020 ) Postpone initiation of treatment by 4 weeks: -Post-Operative Radiotherapy (PORT) NSCLC - Prophylactic Cranial Irradiation (PCI) SCLC Use less treatment sessions: - SABR as possible. - Hypo-F RT regimens ( Bakhribah et al, 2020 ) Extensive-stage SCLC: PCI - Stage I NSCLC: 45 - 54 Gy /3 frs or 48 - 50 Gy / 4 or 5 frs or 30 - 34 Gy /1 fr in select patients (SBRT/ablation) - Locally advanced NSCLC (stage III): 60 Gy / 24 frs or 55 Gy / 20 frs or up to 60 Gy / 15 frs (Hypo-F RT schedule) - Limited-stage SCLC: twice-per-day RT (cCRT) PCI for age < 75 yrs ( Singh et al, 2020 ) Extensive SCLC (PCI or palliative intent) Locally advanced (palliative): - 40 Gy / 15 frs - 39 Gy / 13 frs - 16 Gy / 2 frs ( Kochbati et al, 2020 ) SCLC, Extensive: - PCI - Consolidation thoracic RT in extensive-stage disease Stage I-IIIB tumor operated: Short delay in RT if R0 resection NSCLC, T1/2N0M0, medically inoperable; peripheral: -SBRT 30-34 Gy/single fr (T1 N0M0) -54 Gy / 3 frs in 1.5 weeks (Eligibility includes T1, 2 (<5 cm), T3 < 5 cm, chest wall involvement positive, no mediastinal or bronchial tree invasion) -48 Gy / 4 frs daily RT NSCL, T1/2N0M0, medically inoperable, central: - 60 Gy / 8 daily frs -70 Gy / 10 daily frs -50 Gy / 5 daily frs Stage III, Locally advanced NSCLC: -55 Gy / 20 frs with concurrent /sequential chemotherapy -60 Gy /15-20 frs NSCLC, advanced- inoperable, large for Palliative RT: 8 - 10 Gy/1-2 frs SCLC, localized: 40-42 Gy /15 daily frs ( Hinduja et al, 2020 ) Curative treatment for stage III NSCLC: Hypo-F in cCRT strategy (60–66 Gy / 22–30 frs and 50 Gy / 20 frs) Inoperable stage II-III NSCLC Limited stage SCLC Palliative NSCLC (spinal cord compression or SVCO) Early-stage NSCLC: SABR:30–34 Gy /1 fr to 48–54 Gy / 3 frs Central tumors: Hypo-F RT (50–60 Gy /15 frs) Inoperable early-stage NSCLC and operable NSCLC: SBRT Stage II NSCLC: definitive RT ( Stepanović and Nikitović, 2020 ) Adjuvant RT (pathological N2 or R1 post-op): after chemotherapy or 3 months after surgery Early-stage disease: SBRT for tumors <2.0 cm (a single fraction of 30 − 34 Gy) Adjuvant...…”

Severity of COVID-19 in patients with lung cancer: evidence and challenges

“…55 While data demonstrating the effect of COVID-19 specifically on lung cancer research is scant, several studies show that cancer research in general has been compromised. [56][57][58][59][60][61][62][63] Cancer clinical trials have been at the focus of these studies, but it is essential to highlight that translational and observational studies have also been affected. 57 The mechanisms by which research has been compromised include decreased funding, operational concerns with tissue collection and biobanking, holds on clinical trials, reduced workforce, and reduced networking opportunities for international collaborations.…”

Perspective: Did Covid-19 Change Non-small Cell Lung Cancer Surgery Approach?

“…The factors that have led to a major change in the management of patients with lung cancer are manifold. The reduction in the availability of hospital beds has led to a delay in medical and surgical care for patients with lung cancer ( 10 ). Screening programs were temporarily interrupted and patients did not feel confident about going through regular visits and follow-ups ( 4 , 6 , 11 , 12 ).…”