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Weng J, Dabaja B, Das P, Gunn G, Chronowski G, Bloom E, Lee P, Koong A, Ning M, Semien K, Sanders C, Ritchey R, Nguyen K, Hoffman K, Robinson I, Kerr A, Brokaw J, Liao Z, Nguyen Q. Radiation Therapy Decision Making Process and Operations for COVID-19 Positive Patients. Int J Radiat Oncol Biol Phys 2022. [PMCID: PMC9595469 DOI: 10.1016/j.ijrobp.2022.07.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose/Objective(s) A challenging clinical dilemma during the COVID-19 pandemic is management of cancer patients who test positive for COVID. Given the need to balance the risk of disease progression with the risk of transmission to other patients and staff, radiation therapy for these patients requires careful consideration and modification of standard workflows. It is also critical to develop processes to mitigate radiation treatment interruption, which can affect patient outcomes. The objective of this study was to report the clinical operations and outcomes for COVID positive patients receiving radiation therapy during the pandemic at a tertiary cancer center including 2 network locations. Materials/Methods During March 2020 to March 2022, the Radiation Oncology COVID committee (RO COVID) developed an integrated process to triage patients, provide treatment recommendations, and implement infection control procedures to safely deliver radiation therapy to COVID positive patients. Policies were created for each center with multidisciplinary input from infectious disease, radiation oncology, radiation therapy, and nursing. All COVID positive patients were presented to the RO COVID group and evaluated for clinical urgency, benefit with radiation, and life expectancy. If deemed necessary, a limited planned break or hypofractionated regimen was recommended to minimize staff exposure. We conducted a retrospective review of COVID positive patients with different primary malignancies treated through the COVID positive pathway. Results A total of 68 COVID positive patients were treated with the COVID positive pathway (HN 15, Breast 9, CNS 8, GU 8, GYN, 7, Thoracic 6, GI 5, HEME 5, PED 3, SARC 2). The median age was 57.1 years (IQR 45.8-63.4) and 47% were female. There were 39 patients (57%) who were asymptomatic and were tested for routine pre-radiation screening or due to concerns of COVID exposure. Twenty-three (34%) patients were treated with palliative intent and 8 (12%) were treated for an emergent indication (i.e., spinal cord compression, bleeding). Thirteen (19%) patients were receiving radiation treatment, had a treatment break (7-21 days), and then resumed their radiation course. All treatments were successfully completed without known nosocomial spread of COVID to staff or other patients. Among this heterogenous group of patients, 58 (85%) were alive with a median follow up of 2 months (IQR 0.5-7.5). COVID infection may have contributed to 3 out of 10 deaths (4% of total cohort). The remaining deaths were due to progression of disease or other non-COVID causes. Conclusion In this study, COVID positive patients were safely treated with radiation therapy through a comprehensive decision making and clinical operations pathway taking into account evolving COVID guidelines for three different variant surges. Although limited in follow up, patient outcomes are promising with few COVID-related deaths and low overall mortality rates, even with hypofractionated regimens.
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Affiliation(s)
- J. Weng
- MD Anderson Cancer Center, Houston, TX,Corresponding author:
| | - B. Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - P. Das
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - G.B. Gunn
- MD Anderson Cancer Center, Houston, TX
| | - G.M. Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - P. Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A.C. Koong
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M.S. Ning
- MD Anderson Cancer Center, Houston, TX
| | - K. Semien
- MD Anderson Cancer Center, Houston, TX
| | | | | | - K. Nguyen
- MD Anderson Cancer Center, Houston, TX
| | - K.E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - I. Robinson
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A. Kerr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J. Brokaw
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Z. Liao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Q.N. Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Augustyn A, Reed V, Ahmad N, Bhutani M, Bowers J, Bloom E, Chronowski G, Das P, Jr EH, Delclos M, Huey R, Koay E, Lee S, Taniguchi C, Koong A, Chun S. Implementation of a Stereotactic Body Radiotherapy Program for Unresectable Pancreatic Cancer in an Integrated Community Academic Radiation Oncology Satellite Network. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reddy J, Lei X, Bloom E, Reed V, Schlembach P, Arzu I, Gopal R, Mayo L, Chun S, Ahmad N, Stauder M, Chronowski G, Weed D, Delclos M, Garg A, Shaitelman S, Fang P, Tereffe W, Woodward W, Smith B. Optimizing Preventive Adjuvant LINAC (OPAL) Radiation: A Phase II Trial of Daily Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moningi S, Kuban D, Allen P, Kanke J, Master P, Anscher M, Chapin B, Choi S, Chun S, Chronowski G, Delclos M, Garg A, Mayo L, McGuire S, Nguyen Q, Pettaway C, Schlembach P, Shah S, Tang C, Hoffman K. Prospective Cancer Control and Patient-reported Quality of Life after Post-prostatectomy Salvage Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nelson C, Chun S, Spicer C, Bloom E, Chronowski G, Nguyen Q, Kirsner S. A Dosimetric Comparison of 3D-Conformal Arc Technique With Static AP/PA and Four Field Radiation Therapy for the Palliation of Spinal Metastases. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shaitelman S, Buchholz T, Hunt K, Hortobagyi G, Schlembach P, Arzu I, Bloom E, Chronowski G, Dvorak T, Grade E, Hoffman K, Perkins G, Reed V, Shah S, Stauder M, Strom E, Tereffe W, Woodward W, Ensor J, Smith B. Hypofractionated Whole Breast Irradiation Results in Less Acute Toxicity and Improved Quality of Life at Six Months Compared to Conventionally Fractionated Whole Breast Irradiation: Results of a Randomized Trial. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.10.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chao K, Asper J, Chen H, Ahamad A, Raben A, Chronowski G, Strasser J, Frank S, Koprowski C, Dong L. 81. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chronowski G, Wilder R, Tucker S, Ha C, Hagemeister F, Barista I, Younes A, Hess M, Cabanillas F, Cox J. Analysis of in-field control and late complications in adults with 533 Hodgkin’s disease sites treated with combined modality therapy. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)02492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Laurie SA, Pfister DG, Kris MG, Tong WP, Chronowski G, Pisters KM, Heelan RT, Sirotnak FM. Phase I and pharmacological study of two schedules of the antifolate edatrexate in combination with cisplatin. Clin Cancer Res 2001; 7:501-9. [PMID: 11297240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The antifolate edatrexate has shown moderate activity against cancers of the head and neck and non-small cell lung cancer, as has cisplatin. Edatrexate demonstrates synergy with cisplatin in transplanted tumor models. This Phase I study was designed to evaluate two schedules of administration of cisplatin in combination with escalating doses of edatrexate, in a population consisting mainly of patients with these two cancers. The starting dose of edatrexate was 40 mg/m2. Dose escalation was to occur in 10-mg/m2 increments; the planned maximum dose level for study was 80 mg/m2. A total of 39 patients were registered. Eleven were treated on schedule A: cisplatin 120 mg/m2 every 4 weeks, and edatrexate weekly. Twenty-eight patients were assigned to schedule B: cisplatin 60 mg/m2 and edatrexate, both given every 2 weeks. On schedule A, the maximum tolerated dose of weekly edatrexate was 40 mg/m2, with dose-limiting toxicities of leukopenia, mucositis, and renal insufficiency. On schedule B, the maximum tolerated dose of biweekly edatrexate was 80 mg/m2, with leukopenia and mucositis as dose limiting. For schedule A, pharmacokinetic studies suggested a possible effect of cisplatin on the day 8 clearance of edatrexate. Studies on patients on schedule B did not show a clear effect of cisplatin on the day 15 edatrexate clearance. On schedule A, 5 of 9 evaluable patients had major responses (1 complete); whereas on schedule B, 8 of 25 patients had major responses (1 complete). Responses were seen in both head and neck and non-small cell lung cancer patients. For Phase II studies, use of cisplatin 60 mg/m2 and edatrexate 80 mg/m2, both given biweekly, is recommended.
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Affiliation(s)
- S A Laurie
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, New York 10021, USA
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