Radiation Therapy Delivery Challenges in Older Patients During Coronavirus Disease 2019 Pandemic

Mohamed Aziz Cherif; Gokoulakrichenane Loganadane; Kamel Debbi; Gabriele Coraggio; Sahar Ghith; Asma Hadhri; Wissal Hassani; Noémie Grellier; Nhu Hanh To; Yazid Belkacemi

doi:10.1016/j.adro.2020.11.011

Radiation Therapy Delivery Challenges in Older Patients During Coronavirus Disease 2019 Pandemic

Adv Radiat Oncol. 2021 Jul-Aug;6(4):100626. doi: 10.1016/j.adro.2020.11.011. Epub 2020 Dec 5.

Authors

Mohamed Aziz Cherif^{1

2}, Gokoulakrichenane Loganadane¹, Kamel Debbi¹, Gabriele Coraggio^{1

2}, Sahar Ghith¹, Asma Hadhri¹, Wissal Hassani¹, Noémie Grellier^{1

2}, Nhu Hanh To^{1

3}, Yazid Belkacemi^{1

2

3}

Affiliations

¹ AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France.
² Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network.
³ INSERM Unit 955; Team 21, IMRB, University of Paris-Est (UPEC), Creteil, France.

Abstract

Purpose: The management of older patients in radiation therapy (RT) departments has been challenging in the context of the Coronavirus Disease 2019 (COVID-19) outbreak. We report our experience of RT adapted schedules or strategy changes in older patients during the COVID-19 pandemic.

Methods and materials: Patients aged ≥75 years were recruited during weekly chart rounds. All were potentially eligible for a specific intervention to reduce the frequency of patients' visits to the hospital. The effect of deferring radiation and hypofractionation of RT schedules was assessed in terms of the number of courses initially planned and replanned during the lockdown.

Results: Twenty patients were identified during the official lockdown in France (March 17 to May 11). Median age was 78 years (75-95 years). Most patients were male (n = 12, 60%) being treated in the postoperative setting (n = 17, 85%). RT was delayed in 11 cases (55%) with hormonal therapy prescribed in 10 cases (50%). Altered RT fractionation was proposed for 5 cases (25%); combinations of altered fractionation and deferral of radiation were applied in 3 cases (15%). The number of radiation courses initially planned and replanned according to the pandemic context: 563 and 197, respectively (-62%; P < .001). None presented recurrence when RT was initiated, and no patient developed symptomatic COVID-19 infection.

Conclusions: In the context of the COVID-19 outbreak, individual risk-based radiation therapy seems to be safe. Systematic screening of patients for COVID-19 before starting radiation therapy is mandatory. In our department the oncogeriatrics expertise availability for daily practice was of great use during the pandemic. Other prospective studies are needed to validate such strategies in case of resurgence of similar outbreaks.