3.3 Impact of COVD-pandemic on HNC patients
Forty-three patients were included in the analysis. During the first two months of the COVID19 pandemic a slightly higher number of patients were treated at our Department as compared with the same period of 2019 (44 vs 36, respectively, +22%). This could be probably explained by the fact that as a hub center, some patients were referred from other Institutions. All patients received image-guided Intensity Modulated Volumetric Arch Therapy (VMAT). Two patients maintained their tracheostomy positioned at time of surgery. Patients’ and treatment characteristics are provided in Table 2 .
Postoperative RT was started after a median time of 58 (IQR 53-69) days for the 17 patients treated with surgery. Exclusive RT was initiated after a median time of 29 (IQR 20-42) days following the first clinical examination performed by the Radiation Oncologist (22 patients). For the 4 patients who had undergone induction chemotherapy, a median time to RT start was 24 (IQR 14-30) days from the last cycle.
Median OTT was 50 (IQR: 47-54.25) days. Overall, RT was interrupted/delayed in seven patients (16%) as a consequence of a suspected COVID-19 infection. Specifically:
- One patient presenting with fever was diagnosed with COVID-19- related pneumonia on March 4th after receiving 18 Gy out of the prescription dose of 70 Gy for cT1cN2M0 HPV-positive oropharyngeal cancer, TNM 8th edition18. The patient required hospitalization for intensive respiratory distress of COVID-19 related pneumonitis and was treated at an intensive care unit of a dedicated COVID-19 hospital. After a quarantine period the patient was proven negative at two consecutive nasal swabs (7th April). Due to a prolonged interruption of 57 days, after multidisciplinary discussion, a salvage surgery ± post-operative RT according to pathology specimen findings was proposed.
- Four patients had their RT interrupted following the onset fever. Nasal swabs tests were negative in all cases. RT breaks was 2 days for all patients.
- One patient interrupted curative RT for 23 days due to the quarantine measurements of her residence area. Treatment was interrupted at the dose of 62 Gy. OTT time was 105 days (further interruptions were needed for severe skin RT-induced toxicity).
- One patient with oral cavity cancer is experiencing a delay in the beginning of his adjuvant therapy. Following surgery, he subsequently developed COVID-19 pneumonia. Despite two consecutive swabs detected no sign of infection, the third one proved to be positive. Further two consecutive swabs performed recently demonstrated absence of COVID-19 infection. The patients is actually scheduled to start postoperative RT which will be performed after 71 days from surgery.
Overall, follow-up consultations were regularly performed until April 19th 2020. Telehealth surveillance subsequently performed for 21 patients. Among these three patients who had completed their RT course, were scheduled for a short-term consultation for a more comprehensive assessment (tracheostomy removal, toxicity evaluation and physical assessment of gross tumor response, respectively).