Practical Practice Recommendations for Lung Cancer Radiotherapy During the COVID-19 Pandemic: An ESTRO-ASTRO Consensus Statement-1-s2.0-S0167814020301821-main

1-s2.0-S0167814020301821-main

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The COVID-19 pandemic has had a significant impact on the resources available for lung cancer radiotherapy and has increased risks for both patients and healthcare staff. In response, an international group of experts in lung cancer radiotherapy has established practice recommendations on whether and how to adapt radiotherapy for lung cancer during the pandemic. <br /><br />In the early phase of the pandemic, the experts recommend not compromising the prognosis of lung cancer patients and not deviating from guideline-recommended radiotherapy practice. Treatment should be postponed or interrupted for COVID-19 positive patients to minimize the risk of infection. They also provide recommendations for the use of hypofractionation, with consensus to consider hypofractionation in certain cases, such as stage I NSCLC and palliative NSCLC. <br /><br />In scenarios where there is a lack of radiotherapy resources, the experts recommend further hypofractionation as appropriate for certain cases, such as stage III NSCLC and limited stage SCLC. They also recommend regular contrast-enhanced cranial MRI follow-up instead of prophylactic cranial irradiation (PCI) for SCLC patients to preserve capacity. <br /><br />When it comes to prioritizing patients and triaging for treatment, factors such as potential for cure, relative benefit of radiation, life expectancy, and performance status should be considered. The experts also provide recommendations on the top five factors to use for triage in a setting with limited resources. <br /><br />It should be noted that these recommendations are not absolute and should be adapted to individual clinical situations. The experts encourage practitioners to exercise their own clinical judgement and to consider local logistical and financial aspects, as well as legal frameworks and cultural contexts.

Keywords

COVID-19 pandemic

lung cancer radiotherapy

patient risks

healthcare staff risks

practice recommendations

radiotherapy adaptation

hypofractionation

radiotherapy resources

patient prioritization

limited resources