Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic

被引:27
|
作者
Kumar, Sameera [1 ]
Chmura, Steven [2 ]
Robinson, Clifford [3 ]
Lin, Steven H. [4 ]
Gadgeel, Shirish M. [5 ]
Donington, Jessica [6 ]
Feliciano, Josephine [7 ]
Stinchcombe, Thomas E. [8 ]
Werner-Wasik, Maria [9 ]
Edelman, Martin J. [10 ]
Moghanaki, Drew [11 ]
机构
[1] Fox Chase Canc Ctr, Dept Radiat Oncol, 333 Cottman Ave, Philadelphia, PA 19111 USA
[2] Univ Chicago, Dept Radiat & Cellular Oncol, Chicago, IL 60637 USA
[3] Washington Univ, Dept Radiat Oncol, St Louis, MO 63110 USA
[4] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
[5] Univ Michigan, Dept Internal Med, Div Hematol & Oncol, Ann Arbor, MI 48109 USA
[6] Univ Chicago, Dept Surg, 5841 S Maryland Ave, Chicago, IL 60637 USA
[7] Johns Hopkins Univ, Dept Med Oncol, Baltimore, MD USA
[8] Duke Univ, Dept Med Oncol, Durham, NC USA
[9] Thomas Jefferson Univ, Dept Radiat Oncol, Philadelphia, PA 19107 USA
[10] Fox Chase Canc Ctr, Dept Hematol & Med Oncol, 7701 Burholme Ave, Philadelphia, PA 19111 USA
[11] Emory Univ, Atlanta Vet Affairs Hlth Care Syst, Dept Radiat Oncol, Atlanta, GA 30322 USA
关键词
Non-small cell lung cancer; Locally advanced; COVID; SARS-CoV-2; CELL LUNG-CANCER; POSITRON-EMISSION-TOMOGRAPHY; PHASE-II TRIAL; RADIATION-THERAPY; HYPOFRACTIONATED RADIOTHERAPY; CONCURRENT CHEMOTHERAPY; COVID-19; CHEMORADIOTHERAPY; CHEMORADIATION;
D O I
10.1016/j.jtho.2020.04.016
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (LA-NSCLC) may require treatment in locations where resources are limited, and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The over-arching goals of these approaches are the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome-coronavirus-2, (3) attenuate the immunocom-promising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with de finitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of patient factors and clinical resources. Whenever radiation therapy is delivered without concurrent chemotherapy, hypo-fractionated schedules are appropriate. For patients who are con firmed to have COVID-19, usually, cancer therapies may be withheld until symptoms have resolved with negative viral test results. The risk of severe treatment-related morbidity and mortality is increased for patients undergoing treatment for LA-NSCLC during the COVID-19 pandemic. Adapting alternative treatment stra-tegies as quickly as possible may save lives and should be implemented through communication with the multidisci-plinary cancer team. (C) 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:1137 / 1146
页数:10
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