1.1 Peculiarities of HNC clinical management
With a number of incident and prevalent cases in Lombardy of 1583 and
2687 in 2019, respectively, HNCs can be considered as relatively rare.
Nevertheless, a recent national Italian survey among Radiation Oncology
facilities has shown that the majority of COVID-19 positive oncological
patients had a diagnosis of either lung or HN cancers and had their
domicile in Lombardy1.
For the Radiation Oncologist HNC patients in the
COVID-era8 the following peculiarities should be
considered: 1) HNC are non-deferrable treatments9,10,
2) increase in overall treatment time (OTT) negatively affects survival
in curative-intent treatments5,6 , 3) patients are
generally elderly, heavy smokers as well as affected by several
comorbidities 11–13 4) as curative-intent RT is
administrated in 25-35 fractions, patients are required to perform
multiple hospital accesses, which may increases their risk of
contagion7, 5) the need of removing patient’s surgical
masks in different phases of RT favors environmental dissemination of
droplets5, 5) the frequent presence of a tracheostomy
represents a further mean of viral spreading14, 6)
abundant mucous secretions with cough secondary to tumor- and
treatment-related distress might further favor cross-infections, 7) high
risk of developing ab-ingestis pneumonitis as a consequence of tumor
and/or treatment-related swallowing impairment could make patients prone
to pulmonary distress syndromes15, and 8) the combined
effect of RT and concomitant systemic treatments (mainly platinum-based
chemotherapy) could result in myelosuppression, thus favoring infectious
disease 16 .