Radiation therapy considerations during the COVID‐19 Pandemic: Literature review and expert opinions

1 More than 662,000 cases have been reported in the United States with more than 29,000 deaths. 2 The overall crude mortality rate now stands at 6.6% (may possibly be lower due to under‐testing and under‐reporting of total confirmed cases), and is highly dependent on age group, comorbidities, and the locoregional resources medically. 1 A report from the United States presented age‐stratified COVID‐19‐associated hospitalization rates among 1,482 patients during March 1–28, 2020, highlighting an alarmingly high rate of 74.5% at age > 50 years with underlining medical conditions. 3 Based on a data summary report provided by New York City Health, as of April 14, 2020, the shares of a total of 6839 deaths reached 0.04%, 4.5%, 23.1%, 24.6%, and 47.7% for the age groups of 0–17, 18–44, 45–64, 65–74, and 75+ years old. 4 All data suggest that adults at a more advanced age group are facing higher morbidity and mortality risks. [...]a very recent case report from M.D. Anderson Cancer Center just revealed an asymptomatic nonsmall cell lung cancer patient who passed regular COVID‐19 screening but demonstrated internal development of multifocal ground glass opacities on the thoracic CT‐on‐rail scan prior to the first fraction of RT treatment. [...]the feasibility of delivering quality assured RT during the pandemic has been called into question leading to the theme of this debate. With nearly 50–60% patients with cancer ultimately needing RT in their lifetime, 22,23 in the setting of deferred chemotherapy and surgery, RT may play an even more important role in management of many cancers. 2.C Infection control measures in radiotherapy clinics WHO has issued key considerations for occupational safety and health and infection prevention and control for health workers during the pandemic. 24,25 The need to use PPE for RT delivery is not a novel challenge in radiation oncology clinics where patients needing contact precautions are routinely treated, especially in clinics attached to in‐patient units.