Radiotherapy for Lung Cancer During the COVID Pandemic – A Narrative Review of Practical Recommendations

"Background: The coronavirus disease pandemic produced changes in the treatment approach of lung cancer patients. They represent a vulnerable population due to the negative impact of delays in diagnosis and treatment and also because of the impaired immune system. Radiation Therapy plays a crucial role in both curative and palliative settings, so finding the best approach for these patients in this context was attempted by many professionals. The aim of this study was to make a synthesis of the current published literature on this topic and summarize the recommendations. Material and methods: We searched the PubMed database for articles published between 20th December 2019 and 30th August 2020. We used 14 key words related to COVID 19 and Lung Cancer. The articles were selected by two senior clinicians who excluded overlapping information and prioritized original research reports and professional organization’s official recommendations. Results: There were 562 papers corresponding to the search criteria, of which 64 were analyzed. Treatment decision must be tailored according to the status of SARS CoV-2 positivity, the aim of the treatment (curative VS palliative), pathological type and clinical stage, disease complications, symptoms, prognostic, performance status, and alternative treatments. Hypofractionation is preferred whenever possible in order to minimize risk for patients and staff. Safety measures have to be implemented, with extra cautions if SARS CoV-2 positive patients have to be treated. Cone beam CT can be used early identification of lung infiltrates and special attention is recommended to differentiate Radiation pneumonitis from COVID-19 pneumonia. Journal of Medical and Radiation Oncology Journal homepage: www.jmedradonc.org Review 94 Conclusion: For SARS CoV-2 positive lung cancer patients the treatment should be postponed, until they are tested negative. For patients which are SARS CoV-2 negative treated with curative intent, hypofractionated schedules are preferred. Palliative treatments should be given according to the life threatening risk."