1. INTRODUCTION
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 12th 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
infection2,3. Following the Regional resolution
XI-2906 approved on the 8th 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
perspective4–6. 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.Daniela Alterio*1, Stefania Volpe*ⴕ1,2, Giulia Marvaso1,2, Irene Turturici1, Annamaria Ferrari1, Maria Cristina Leonardi1, Roberta Lazzari1, Massimo Sarra Fiore1, Giammaria Bufi1, Federica Cattani3, Camilla Arrobbio1,2, Filippo Patti1,2, Alessia Casbarra1,2, Iacopo Cavallo1,2, Fabrizio Mastrilli4, Roberto Orecchia5, Barbara Alicja Jereczek-Fossa1,2
1. Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
3. Medical Physics Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
4. Medical Administration, CMO, IEO, European Institute of Oncology, IRCCS, Milan, Italy
5. Scientific Direction, IEO, European Institute of Oncology IRCCS, Milan, Italy
* Daniela Alterio MD and Stefania Volpe MD equally contributed to the present work, and should be considered as co-first authors
Corresponding Author:
Stefania Volpe MD
Orcid ID https://orcid.org/0000-0003-0498-2964
Conflicts of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Funding statement and Acknowledgements: This study was partially supported by the Italian Ministry of Health with “Progetto di Eccellenza”. Stefania Volpe MD is a PhD student within the European School of Molecular Medicine (SEMM).
ABSTRACT
Background: Management of head and neck cancers (HNC) in Radiation Oncology in the COVID-19 era is challenging. Aim of our work is to report organization strategies at a Radiation Therapy (RT) Department in the first European area experiencing the COVID-19 pandemic. Methods: We focused on 1) dedicated procedures for HNC, 2) radiation treatment scheduling and 3) healthcare professionals’ protection applied during the Covid-19 breakdown (from 1st March to 30th April 2020). Results: Applied procedures are reported and discussed. Forty-three pts were treated. Image-guided, Intensity Modulated RT was performed in all cases. Median overall treatment time (OTT) was 50 (IQR: 47-54.25) days. RT was interrupted/delayed in seven pts (16%) for suspected COVID-19 infection. Two health professionals managing HNC pts were proven as COVID-19 positive. Conclusion: Adequate and well-timed organization allowed for the optimization of HNC pts balancing at the best of our possibilities pts’ care and personnel’s safety.