Chinese expert consensus on issues related to radiotherapy management of cancer patients under the back ground of COVID-19 （2023 Edition）

Abstract

Abstract:

The ongoing COVID-19 pandemic has posed unprecedented challenges to global healthcare systems and has had a specific impact on the standard treatment of cancer patients worldwide， including radiotherapy. Resource constraints can lead to a decline in treatment capacity， and to reduce the risk of cancer patients being exposed to the novel coronavirus， the number of radiotherapy visits must be limited. Based on existing clinical evidence， radiation oncologists need to make radiotherapy decisions that reduce the risk of infection without compromising efficacy. The COVID-19 pandemic is nearing its end， but more infectious variants or other viruses may emerge and spread. Therefore， the Radiation Oncology Treatment Physician Branch of the Chinese Medical Doctor Association， the Radiation Oncology Therapy Branch of the Chinese Medical Association， and the Chinese Association of Radiation Therapy of the China Anti-Cancer Association refer to a number of relevant guidelines and the latest updates on patients with malignant tumors during the COVID-19 epidemic at home and abroad. According to China's national conditions， medical system and COVID-19 epidemic characteristics， the "Chinese expert consensus on issues related to radiotherapy management of cancer patients under the background of COVID-19 （2023 Edition）" is formulated.

Key words:COVID-19,Radiotherapy,Neoplasms,Clinical consensus

Radiation Oncology Treatment Physician Branch, Chinese Medical Doctor Association； Radiation Oncology Therapy Branch, Chinese Medical Association； Chinese Association of Radiation Therapy, China Anti-Cancer Association. Chinese expert consensus on issues related to radiotherapy management of cancer patients under the back ground of COVID-19 （2023 Edition）[J]. Journal of International Oncology, 2023, 50(10): 577-584.

Figures/Tables2

质量等级	定义
Ⅰ级（高质量）	进一步研究也不可能改变该疗效评估结果的可信度
Ⅱ级（中等质量）	进一步研究很可能影响该疗效评估结果的可信度，且可能改变该评估结果
Ⅲ级（低质量）	进一步研究极有可能影响该疗效评估结果的可信度，且该评估结果极有可能被改变
Ⅳ级（极低质量）	任何疗效评估结果都很不确定

推荐级别	定义
强推荐	基于可获得证据，非常确定获益大于风险和负担，则做出强推荐
弱推荐	基于可获得证据，认为获益、风险和负担相当平衡，或获益、风险的程度存在明显不确定性，则做出弱推荐

References46

[1]	Zaorsky NG, Yu JB, McBride SM, et al. Prostate cancer radiation therapy recommendations in response to COVID-19[J].Adv Radiat Oncol,2020,5(4): 659-665. DOI:10.1016/j.adro.2020.03.010. pmid:32292839
[2]	NICE.COVID-19 rapid guideline: delivery of radiotherapy[M]//National Institute for Health and Care Excellence: Clinical Guidelines. London: National Institute for Health and Care Excellence (NICE),2021.
[3]	Ontario Health.Pandemic Planning Clinical Guideline for Patients with Cancer[Z]. (2020-03-10)[2023-06-25]. https://obgyn.utoronto.ca/sites/default/files/oh-cco_pandemic_planning_clinical_guideline_final_2020-03-10_002.pdf.
[4]	Rathod S, Dubey A, Bashir B, et al. Bracing for impact with new 4R's in the COVID-19 pandemic—a provincial thoracic radiation oncology consensus[J].Radiother Oncol,2020,149: 124-127. DOI:10.1016/j.radonc.2020.03.045.
[5]	Dietz JR, Moran MS, Isakoff SJ, et al. Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. The COVID-19 pandemic breast cancer consortium[J].Breast Cancer Res Treat,2020,181(3): 487-497. DOI:10.1007/s10549-020-05644-z.
[6]	de Azambuja E, Trapani D, Loibl S, et al. ESMO management and treatment adapted recommendations in the COVID-19 era: breast cancer[J].ESMO Open,2020,5(Suppl 3): e000793. DOI:10.1136/esmoopen-2020-000793.
[7]	Curigliano G, Cardoso MJ, Poortmans P, et al. Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic[J].Breast,2020,52: 8-16. DOI:10.1016/j.breast.2020.04.006. pmid:32334323
[8]	Rathod S, Jeremic B, Dubey A, et al. Role of thoracic consolidation radiation in extensive stage small cell lung cancer: a systematic review and meta-analysis of randomised controlled trials[J].Eur J Cancer,2019,110: 110-119. DOI:10.1016/j.ejca.2019.01.003. pmid:30785014
[9]	Slotman BJ, van Tinteren H, Praag JO, et al. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial[J].Lancet,2015,385(9962): 36-42. DOI:10.1016/S0140-6736(14)61085-0. pmid:25230595
[10]	Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer[J].N Engl J Med,2007,357(7): 664-672. DOI:10.1056/NEJMoa071780.
[11]	Takahashi T, Yamanaka T, Seto T, et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial[J].Lancet Oncol,2017, 18(5): 663-671. DOI:10.1016/S1470-2045(17)30230-9.
[12]	Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343[J].J Clin Oncol,2013,31(19): 2382-2387. DOI:10.1200/JCO.2012.45.2615. pmid:23690420
[13]	Kunkler IH, Williams LJ, Jack WJ, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME Ⅱ): a randomised controlled trial[J].Lancet Oncol,2015, 16(3): 266-273. DOI:10.1016/S1470-2045(14)71221-5.
[14]	Braunstein LZ, Gillespie EF, Hong L, et al. Breast radiation therapy under COVID-19 pandemic resource constraints—approaches to defer or shorten treatment from a comprehensive cancer center in the United States[J].Adv Radiat Oncol,2020,5(4): 582-588. DOI:10.1016/j.adro.2020.03.013. pmid:32292842
[15]	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[J].Int J Radiat Oncol Biol Phys,2020,107(4): 618-627. DOI:10.1016/j.ijrobp.2020.04.016.
[16]	Boettler T, Newsome PN, Mondelli MU, et al. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper[J].JHEP Rep,2020,2(3): 100113. DOI:10.1016/j.jhepr.2020.100113.
[17]	Lin YK, Hsu HL, Lin WC, et al. Efficacy of postoperative radiotherapy in patients with pathological stage N₂epidermal growth factor receptor wild type adenocarcinoma and squamous cell carcinoma lung cancer[J].Oncotarget,2017,8(21): 35280-35288. DOI:10.18632/oncotarget.13257.
[18]	Kim BH, Kim HJ, Wu HG, et al. Role of postoperative radiotherapy after curative resection and adjuvant chemotherapy for patients with pathological stage N₂non-small-cell lung cancer: a propensity score matching analysis[J].Clin Lung Cancer,2014,15(5): 356-364. DOI:10.1016/j.cllc.2014.05.005.
[19]	Drake JA, Portnoy DC, Tauer K, et al. Adding radiotherapy to adjuvant chemotherapy does not improve survival of patients with N₂lung cancer[J].Ann Thorac Surg,2018,106(4): 959-965. DOI:10.1016/j.athoracsur.2018.04.074.
[20]	Arrieta O, Cardona AF, Lara-Mejía L, et al. Recommendations for detection, prioritization, and treatment of thoracic oncology patients during the COVID-19 pandemic: the THOCOoP cooperative group[J].Crit Rev Oncol Hematol,2020,153: 103033. DOI:10.1016/j.critrevonc.2020.103033.
[21]	Aupérin A, Arriagada R, Pignon JP, et al. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group[J].N Engl J Med,1999,341(7): 476-484. DOI:10.1056/NEJM199908123410703.
[22]	Takada M, Fukuoka M, Kawahara M, et al. Phase Ⅲ study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104[J].J Clin Oncol,2002,20(14): 3054-3060. DOI:10.1200/JCO.2002.12.071.
[23]	Murray N, Coy P, Pater JL, et al. Importance of timing for thoracic irradiation in the combined modality treatment of limited-stage small-cell lung cancer. The National Cancer Institute of Canada Clinical Trials Group[J].J Clin Oncol,1993,11(2): 336-344. DOI:10.1200/JCO.1993.11.2.336. pmid:8381164
[24]	Fried DB, Morris DE, Poole C, et al. Systematic review evaluating the timing of thoracic radiation therapy in combined modality therapy for limited-stage small-cell lung cancer[J].J Clin Oncol,2004,22(23): 4837-4845. DOI:10.1200/JCO.2004.01.178. pmid:15570087
[25]	Stinchcombe TE, Gore EM. Limited-stage small cell lung cancer: current chemoradiotherapy treatment paradigms[J].Oncologist,2010,15(2): 187-195. DOI:10.1634/theoncologist.2009-0298. pmid:20145192
[26]	Guckenberger M, Belka C, Bezjak A, et al. Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: an ESTRO-ASTRO consensus statement[J].Int J Radiat Oncol Biol Phys,2020,107(4): 631-640. DOI:10.1016/j.ijrobp.2020.05.012.
[27]	Olivotto IA, Lesperance ML, Truong PT, et al. Intervals longer than 20 weeks from breast-conserving surgery to radiation therapy are associated with inferior outcome for women with early-stage breast cancer who are not receiving chemotherapy[J].J Clin Oncol,2009,27(1): 16-23. DOI:10.1200/JCO.2008.18.1891. pmid:19018080
[28]	Karlsson P, Cole BF, Colleoni M, et al. Timing of radiotherapy and outcome in patients receiving adjuvant endocrine therapy[J].Int J Radiat Oncol Biol Phys,2011,80(2): 398-402. DOI:10.1016/j.ijrobp.2010.02.042.
[29]	Vujovic O, Yu E, Cherian A, et al. Time interval from breast-conserving surgery to breast irradiation in early stage node-negative breast cancer: 17-year follow-up results and patterns of recurrence[J].Int J Radiat Oncol Biol Phys,2015,91(2): 319-324. DOI:10.1016/j.ijrobp.2014.10.006.
[30]	National Comprehensive Cancer Network NCCN. NCCN Guidelines^®Insights—Myelodysplastic Syndromes, version 3.2022[EB/OL]. [2023-06-25]. https://education.nccn.org/node/91068.
[31]	中国抗癌协会肿瘤支持治疗专业委员会, 中国抗癌协会肿瘤临床化疗专业委员会. 新型冠状病毒肺炎疫情期间实体肿瘤患者防护和诊治管理相关问题中国专家共识(2022版)[J].中华肿瘤杂志,2022,44(10): 1083-1090. DOI:10.3760/cma.j.cn112152-20220505-00309.
[32]	Achard V, Tsoutsou P, Zilli T. Letter from Switzerland[J].Int J Radiat Oncol Biol Phys,2020,107(3): 600-601. DOI:10.1016/j.ijrobp.2020.03.008.
[33]	Thomson DJ, Yom SS, Saeed H, et al. Radiation fractionation schedules published during the COVID-19 pandemic: a systematic review of the quality of evidence and recommendations for future development[J].Int J Radiat Oncol Biol Phys,2020,108(2): 379-389. DOI:10.1016/j.ijrobp.2020.06.054.
[34]	Alterio D, Volpe S, Bacigalupo A, et al. Head and neck radiotherapy amid the COVID-19 pandemic: practice recommendations of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)[J].Med Oncol,2020,37(10): 85. DOI:10.1007/s12032-020-01409-2. pmid:32808089
[35]	Combs SE, Belka C, Niyazi M, et al. First statement on preparation for the COVID-19 pandemic in large German Speaking University-based radiation oncology departments[J].Radiat Oncol,2020,15(1): 74. DOI:10.1186/s13014-020-01527-1. pmid:32264908
[36]	Gupta T, Ghosh-Laskar S, Agarwal JP. Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: more relevant than ever before in the COVID era[J].Oral Oncol,2020,111: 105045. DOI:10.1016/j.oraloncology.2020.105045.
[37]	Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline[J].Pract Radiat Oncol,2018,8(3): 145-152. DOI:10.1016/j.prro.2018.01.012. pmid:29545124
[38]	Wang SL, Fang H, Song YW, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial[J].Lancet Oncol,2019, 20(3): 352-360. DOI:10.1016/S1470-2045(18)30813-1.
[39]	Tchelebi LT, Haustermans K, Scorsetti M, et al. Recommendations for the use of radiation therapy in managing patients with gastrointestinal malignancies in the era of COVID-19[J].Radiother Oncol,2020,148: 194-200. DOI:10.1016/j.radonc.2020.04.010. pmid:32342878
[40]	van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J].N Engl J Med,2012,366(22): 2074-2084. DOI:10.1056/NEJMoa1112088.
[41]	Walsh TN, Noonan N, Hollywood D, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma[J].N Engl J Med,1996,335(7): 462-467. DOI:10.1056/NEJM199608153350702.
[42]	Curran WJ Jr, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage Ⅲ non-small cell lung cancer: randomized phase Ⅲ trial RTOG 9410[J].J Natl Cancer Inst,2011,103(19): 1452-1460. DOI:10.1093/jnci/djr325.
[43]	Goodman KA, Ou FS, Hall NC, et al. Randomized phase Ⅱ study of PET response-adapted combined modality therapy for esophageal cancer: mature results of the CALGB 80803 (alliance) trial[J].J Clin Oncol,2021,39(25): 2803-2815. DOI:10.1200/JCO.20.03611.
[44]	Hwang JK, Zhang T, Wang AZ, et al. COVID-19 vaccines for patients with cancer: benefits likely outweigh risks[J].J Hematol Oncol,2021,14(1): 38. DOI:10.1186/s13045-021-01046-w.
[45]	王珞, 徐燕, 张路, 等. 肿瘤患者新冠疫苗接种: 临床研究进展与初步临床推荐[J].中国肺癌杂志,2021,24(6): 377-383. DOI:10.3779/j.issn.1009-3419.2021.101.18.
[46]	徐若男, 聂建云, 王涛, 等. 乳腺癌患者新冠疫苗接种中国专家共识[J].传染病信息,2021,34(6): 481-484. DOI:10.3969/j.issn.1007-8134.2021.06.001.