COVID-19 and radiation oncology: the experience of a two-phase plan within a single institution in central Italy

BACKGROUND

COVID-19 in Italy has led to the need to reorganize hospital protocols with a significant risk of interruption to cancer treatment programs. In this report, we will focus on a management model covering the two phases of the COVID-19 emergency, namely lockdown-phase I and post-lockdown-phase II.

METHODS

The following steps were taken in the two phases: workload during visits and radiotherapy planning, use of dedicated routes, measures for triage areas, management of suspected and positive COVID-19 cases, personal protective equipment, hospital environments and intra-institutional meetings and tumor board management. Due to the guidelines set out by the Ministry of Health, oncological follow-up visits were interrupted during the lockdown-phase I; consequently, we set about contacting patients by telephone, with laboratory and instrumental exams being viewed via telematics. During the post-lockdown-phase II, the oncological follow-up clinic reopened, with two shifts operating daily.

RESULTS

By comparing our radiotherapy activity from March 9 to May 4 2019 with the same period in 2020 during full phase I of the COVID-19 emergency, similar results were achieved. First radiotherapy visits, Simulation Computed Tomography and Linear Accelerator treatments amounted to 123, 137 and 151 in 2019 compared with 121, 135 and 170 in 2020 respectively. There were no cases of COVID-19 positivity recorded either in patients or in healthcare professionals, who were all negative to the swab tests performed.

CONCLUSION

During both phases of the COVID-19 emergency, the planned model used in our own experience guaranteed both continuity in radiotherapy treatments whilst neither reducing workload nor interrupting treatment and, as such, it ensured the safety of cancer patients, hospital environments and staff.

Helical tomotherapy re-irradiation for patients affected by local radiorecurrent prostate cancer

Background

Salvage re-irradiation in patients affected by radiorecurrent prostate cancer might be a valid as well as challenging treatment option. The aim of this study was to evaluate feasibility and toxicity of salvage external beam radiotherapy (EBRT) re-treatment in patients affected by radiorecurrent prostate cancer within the prostate gland or the prostate bed.

Materials and Methods

15 patients underwent EBRT re-treatment using helical tomotherapy (HT), with daily Megavolt computed tomography image-guidance. We registered toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Biochemical relapse was defined as a PSA increase > 20% compared with the pre-EBRT re-treatment value. Survival curves were calculated using the Kaplan-Meier method.

Results

All patients received a total dose of 50 Gy (25 × 2 Gy), and 7 (46.6%) had concomitant androgen deprivation therapy (median duration of 12 months). With a median follow-up of 40.9 months, the 2-year and 4-year biochemical relapse-free survival were 55% and 35%, respectively. Acute and late genito-urinary (GU) toxicity ≥2 were recorded in 4 (26.6%) and 5 (33.3%) patients, respectively, and the 4-year late GU toxicity was 30%. Acute gastrointestinal toxicity ≥2 was recorded in 2 (13.3%) cases, whereas no patient experienced late toxicity.

Conclusions

Despite the inherent bias of a retrospective analysis, our long-term results showed a low toxicity profile with a relatively low rate of biochemical control for HT re-treatment in patients affected by local radiorecurrent prostate cancer. Prospective trials are needed to investigate the role of EBRT in this setting.

Spirituality correlates positively with higher quality of life and negatively with depression in a sample of low income brazilian cancer patients

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Background: Brazil has a multicultural mostly poor population with many different kinds of religious affiliations. Since cultural, psychological, spiritual and social factors may influence the quality of life (QOL) of cancer patients, we wanted to evaluate spirituality and its relation to depression and the QOL in a sanple of these patients. Methods: We surveyed 72 adult cancer patients through three questionnaires: a general one, the FACIT-Sp QOL questionnaire, as well as the Beck depression inventory, all of them already validated in Portuguese. From the FACIT-Sp questionnaire we obtained also the general quality of life (FACT-G) score. We evaluated correlations between variables with Chisquare, Fisher and ANOVA tests. Since multiple univariate correlations were assessed in this study, we considered significant only p values equal or bellow 0.005. We employed multiple regression analysis to evaluate if depression and spirituality would independently correlate with QOL. Results: We included 72 patients. The mean age was 52 years, 63.9% were female, 58.3% were married, 20.8% were regularly employed, and 59.7% had studied up to elementary school only. For most patients (66, 2%) their religious faith was the most important factor that helped them to cope with their disease. We found no statistical correlations between the scores of the questionnaire FACIT-Sp and any of the demographic variables. We observed significant correlations between higher scores of spirituality (ANOVA p < 0.001) with the absence of depression. Likewise higher scores of QOL (ANOVA p < 0.001) correlated with lack of depression. By multiple regression analysis both the spirituality dominion of the FACIT-Sp and the Beck depression inventory score correlated independently and significantly with general QOL measured by the FACT-G questionnaire’s score (p = 0.025 and p = 0.004, respectively). Conclusions: Despite the small sample size of our study, it was possible to show that religion is highly regarded by our patients and that it may influence their quality of life independently from depression. Furthermore, spirituality may also be a protective factor against depression. Therefore, physicians respect and encourage their religious practices.

No significant financial relationships to disclose.