Since the 20th February 2020, Italy is experiencing one of the most severe 2019 coronavirus-19 disease (COVID-19) outbreak worldwide, with the region of Lombardy being the first area in Europe hit by the pandemic. At present, Lombardy is the most affected areas in Italy, with 15.116 deaths and 82.904 cases as of 12^th May 2020. Of these, 21.632 were diagnosed in the Milan area. Therefore, health care services across the Region are still facing and unprecedented challenges in limiting transmission rates in order to guarantee the continuity of care¹.

Cancer patients are often frail and immunocompromised, and therefore at risk of being more severely affected by COVID-19 infection^2,3. Following the Regional resolution XI-2906 approved on the 8^th March 2020, selected centers were designated as oncological hubs, meaning that they were called to host patients from hospitals in the frontline for COVID-19 emergency. Since our Institution was included among Lombardy oncological hubs, a set of procedures were implemented in order to guarantee a safe care and working environment.

Several reports and recommendations have been published on the management of head a neck cancer (HNC) from both an ethical and surgical perspective^4–6. Moreover, a recent consensus by the American and European Societies of Radiation Oncology (ASTRO and ESTRO, respectively) was published to provide guidelines on optimal radiation treatment (RT) strategies during the pandemic ⁷. Nevertheless, issues related to the management of HNC patients during RT have not been reported yet. Hence, aim of the current work is to report on technical aspects and the organization strategies applied in a Radiation Oncology facility operating in the first European area hit by the COVID-19 pandemic. As the 4th May represent the end of the lockdown phase in Italy, we wish to share our experience, and to provide some highlights on how everyday activities were re-organized to face an evolving epidemiological scenario, together with the short-term results of our efforts.