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).