A panel of 30 international experts completed a modified rapid Delphi process.  

Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. Specific challenges were identified for patients with HNC: (1) operating room closures leading to increased nonsurgical treatments; (2) altered risk-benefit ratio of chemotherapy and radiation therapy due to increased susceptibility for SARS-CoV-2 infection; (3) a need to suppress SARS-CoV-2 spread by minimizing patient travel and staff exposure; and (4) a potential shortage of radiation therapy resources because of staff sickness. The panel developed treatment recommendations for 5 common head and neck cancer (HNC) cases: oropharynx cancer, early stage larynx cancer, advanced larynx cancer, hypopharynx cancer, and oral cavity cancer. No changes to standard fractionation schedules were favored in early pandemic (risk mitigation), while there was strong agreement to the use of hypofractionation schedules in late pandemic (shortage of radiation therapy resources). 

(Open Access)

Reference (PubMed Link): Thomson DJ, Palma D, Guckenberger M, et al. Practice recommendations for risk-adapted head and neck cancer radiation therapy during the covid-19 pandemic: An astro-estro consensus statement. Int J Radiat Oncol Biol Phys 2020;107:618-627.

Key Institution:  Multi-Institutional (ASTRO-ESTRO)
Keywords: Covid-19, radiation oncology

1035 patients were entered into a multinational COVID-19 and Cancer Consortium (CCC19) database, and 928 met criteria for inclusion. The 30-day all-cause mortality (primary endpoint) was 13%, more than twice the mortality of global average. Factors associated with increased 30-day mortality were: increased age, male sex, smoking status, number of comorbidities, performance status (ECOG status of 2 or higher, active cancer (progressing vs remission), and receipt of azithromycin plus hydroxychloroquine. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality. The 30-day mortality was <10% for those with ECOG PS 0-1 vs. >30% for those with ECOG PS 2-4.  

(Open Access)

Reference (PubMed Link): Kuderer NM, Choueiri TK, Shah DP, et al. Clinical impact of covid-19 on patients with cancer (ccc19): A cohort study. Lancet 2020;395:1907-1918.

Key Institution: Multi-Institutional
Keywords: Covid-19