ESTRO/ASTRO Recommendations on Lung Cancer Radiotherapy During COVID-19 Pandemic
Posted: Wednesday, April 22, 2020
An international panel of 32 experts from Europe, the United States, and Canada have established practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic. The guidelines, which were published in Radiotherapy and Oncology, considered potential adaptations of radiotherapy in two pandemic scenarios.
“This joint ESTRO/ASTRO practice recommendation aims to provide rapid, pragmatic, and balanced guidance in common clinical scenarios of radiotherapy for lung cancer,” stated David Palma, PhD, MD, FRCPC, of Western University, London, Canada, and fellow panel member.
In an early risk-mitigation pandemic scenario where radiotherapy resources remain available, the authors advise that efforts should be made not to compromise the prognosis of patients with lung cancer by considering the risk-benefit ratio of radiotherapy. There was a strong consensus not to postpone radiotherapy in some patients—those with stage III non–small cell lung cancer (NSCLC), limited-stage small cell lung cancer (SCLC) , and palliative NSCLC—and a strong consensus to postpone treatment for others, including postoperative in NSCLC and prophylactic cranial irradiation in SCLC. The experts agreed that radiotherapy should be postponed in all patients testing positive for COVID-19 until they become asymptomatic and the test for COVID-19 is negative to avoid exposure of patients and staff.
In a severe pandemic scenario characterized by reduced resources, the panel recommends the ranking of patients based on relative priority and their perceived priority relative to those with all other types of cancer. In a setting where not all patients can receive radiotherapy due to capacity shortages, there are five factors for triaging patients: (1) potential for cure; (2) relative benefit of radiotherapy versus other treatment options; (3) absence of active COVID-19 infection; (4) life expectancy; and (5) performance status.
Disclosure: For study authors’ disclosures, visit www.sciencedirect.com.
