A year of pandemic for European particle radiotherapy: A survey on behalf of EPTN working group

Proton Therapy Patient Selection Methods and the Impact of COVID-19: A Cross-Sectional International Survey

INTRODUCTION

The COVID-19 outbreak has had far-reaching impacts on cancer services worldwide. It has yet to be described how the pandemic has impacted patient selection methods for proton therapy (PT) specifically. This survey aimed to investigate the current international methods implemented for PT patient selection and to determine whether COVID-19 has impacted PT practice.

METHODS

A 44-question survey was conducted from 29th January 2024 to 18th March 2024 using the Qualtrics platform. PT centres in 21 countries were invited to respond to the survey regarding patient selection methods used currently and prior to the pandemic, as well as impacts of COVID-19 on patient selection and service provision. The survey was disseminated with assistance from The Particle Therapy Co-operative Group.

RESULTS

Nine centres completed the survey: four in Europe, three in the United States of America (USA), and two in Asia. Diagnosis or indications lists, clinical trials group assignment, dose distribution, dose metrics, and expert recommendations were the most reported patient selection approaches within the last five years. Only one centre in the USA reported changes to patient selection approaches during the height of the pandemic, mainly ceasing use of clinical trial group assignment. Six of the nine centres continued to treat patients infected with COVID-19. Five respondents indicated various suspensions or delays for certain treatment groups.

CONCLUSIONS

The findings show most respondents did not alter their patient selection approaches during the pandemic. These findings, however, cannot be generalised to all PT centres due to the small sample size of respondents.

Impact of COVID-19 Pandemic on Carbon-Ion Radiation Therapy in Japan: A Japanese National Registry Study

Purpose

This study aimed to investigate the impact of the COVID-19 pandemic on carbon-ion radiation therapy (CIRT) in Japan by evaluating patient numbers and treatment trends from 2019 to 2022.

Patients and Methods

Data from 5 CIRT facilities were analyzed, encompassing a total of 13 224 patients treated over the 4-year period. Patient demographics, cancer types, treatment protocols, and adherence to national health insurance coverage were examined. The study period was divided into unaffected (2019), significantly affected (2020-2021), and poststabilization (2022) phases, corresponding to progression of the pandemic. For monthly analysis, the period during which a state of emergency was declared by the Japanese government was defined as the pandemic period.

Results

Prostate cancer comprised the majority of CIRT cases (62.4%), followed by hepatocellular carcinoma, bone and soft tissue tumors, locally advanced pancreatic cancer, and nonsquamous cell carcinoma of the head and neck. Despite the pandemic, the annual reduction in CIRT patients remained <5%, suggesting treatment continuity. Analysis of monthly treatment figures revealed a significant reduction in the number of patients with nonprostate cancers treated during the state of emergency, while a reduction in the number of prostate cancer treatments was observed approximately 6 months later. Although the number of COVID-19 patients continued to increase after 2022, the number of patients receiving CIRT increased after the state of emergency was declared.

Conclusion

Although there was a reduction in monthly CIRT patient numbers during the COVID-19 pandemic, yearly analysis revealed that this amounted to <5%.

Proton radiation therapy patient selection and impacts of COVID-19: A scoping review

This scoping review aimed to determine whether the COVID-19 pandemic influenced any modifications to patient selection methods or prioritisation and services provided by proton therapy (PT) centres. This review was conducted based on the PRISMA methodology and Joanna Briggs Institute scoping review guidelines. A literature search was performed in Medline, Embase, Web of Science and Scopus, as well as grey literature. Keywords such as "COVID-19" and "Proton Therapy" were used. Articles published from 1 January 2020 in English were included. In total, 138 studies were identified of which 11 articles met the inclusion criteria. A scoping review design was chosen to capture the full extent of information published relating to the aim. Six of 11 articles included statements regarding treatment of COVID-19 patients. Three publications recommended deferred or alternative treatment, two indicated to treat urgent/emergency patients and one reported continuous treatment for infectious patients. Recurring impacts on PT provision included more frequent use of unconventional therapies, reduced referrals, delayed treatment starts and CT simulation, change in treatment target volumes and staffing limitations due to pandemic restrictions. Consequently, telehealth consults, remote work, reduction in patient visitors, screening procedures and rigorous cleaning protocols were recommended. Few publications detailed changes to patient selection or workflow methods during the pandemic. Further research is needed to obtain more detailed information regarding current global patient selection methods in PT, collecting this data could aid in future planning for PT in Australia.

Observational Study on Antibody Response to COVID-19 Vaccines in PAtients with Gastro-Entero-PanCreatic Cancers and NeuroendocrIne NeoplAsms on Systemic TreatmEnts (VACCINATE)

The coronavirus disease-19 (COVID-19) pandemic dramatically impacted oncological patients' care. Since the introduction of vaccines and the demonstration of their benefit on frail patients, COVID-19 vaccinations were indicated to also be beneficial to oncological population. However, data about the impact of anticancer-treatments and the timing between vaccinations and systemic therapy delivery were not available. We aimed to evaluate potential factors influencing the outcome of the COVID-19 vaccination in cancer patients. We prospectively collected data of patients undergoing the COVID-19 vaccination with gastro-entero-pancreatic and neuroendocrine neoplasms, treated at our institute, between 03/2021 and 12/2021. We enrolled 46 patients, 63.1% males; at the time of data collection, 86.9% had received two-doses of Pfizer-BioNTech and the rest had received the Moderna vaccine. All patients obtained a subsequent immune-response. Chemotherapy seems to determinate a significantly lower antibody response after vaccination compared to the other anti-cancer agents (p = 0.004). No significant effect on immune-response was reported for both vaccinations performed ≤7 vs. >7 days from the last systemic treatment (p = 0.77) and lymphocytes count (p = 0.11). The findings suggest that the optimal timing for COVID-19 vaccination and lymphocytes count are not the issue, but rather that the quality of the subset of lymphocytes before the vaccination determine the efficacy level of immune-response in this population.