3.2 Departmental COVID-19 dedicated procedures
Treatment scheduling was not modified and was followed our Institutional
clinical practice: 6 weeks after surgery, 4 weeks after the last cycle
of induction chemotherapy, within 4 weeks for exclusive radiation or
concurrent chemoradiation).
The whole care path for HNC patients was re-planned according to
temporal and special criteria, with the aim to maintain a safe working
and treating environment. As previously detailed, patients were required
to wear a surgical mask unless otherwise instructed by the personnel. A
second surgical mask was provided to cover tracheotomies, if needed. A
summary of dedicated procedures for HNC patients is provided inTable 1 .
Time management in the COVID-19 pandemic encompassed scheduling all
computed-tomography (CT) simulation scans and RT delivery in dedicated
slots. The rationale beyond these measures was to optimize room
sanitization and to easily provide all involved healthcare professionals
with PPE.
All treatments are performed with mouthpiece-assisted head and shoulder
thermoplastics masks (FirmFit™ Thermoplastics Masks CIVCO Radiotherapy
Corporate Office 2303, Iowa, United States of America), to minimize
intra- and inter-fraction movements during treatment delivery. Due to
our immobilization device of choice, it was not possible for patients to
keep surgical masks during irradiation. For safety reasons, patients
were instructed to wear their surgical mask until they were correctly
positioned on treatment couch. Subsequently, they were invited to remove
the surgical mask and to insert their personalized mouth bites. The
thermoplastic mask could therefore be applied by the Radiation
Therapist, who performed the standard set-up procedures. The temporary
removal of surgical masks by the Radiation Therapist managing HNC
patients’ set-up procedures were considered as a potential source of
contamination, and an adequate PPE was provided accordingly
(Figure 1 ).
Similarly, patients’ surgical masks were removed at least once per week
during medical consultations for oral cavity examination and toxicity
assessment. A consultation room was reserved exclusively for HNC
patients, and sanitized at the end of every working day. Clinical
evaluations during the RT treatment were regularly performed. Follow-up
consultations were organized according to the general Department
procedures detailed in Supplementary Materials . In detail,
follow-up evaluations for HNC patients were organized in the form of
telehealth surveillances, except for those requiring a physical and
radiologic assessment of their gross tumor volume response following a
curative-intent RT. In order to limit the accesses to our Institute,
patients with no evidence of disease and good performance status were
invited to stay at home and to reschedule their consultations.
All the above-mentioned procedures were progressively implemented
according to pandemic development and in accordance with World Health
Organization (WHO), National and recommendations and availability of
Institutional resources17 While COVID-19 phase II
started in Italy on May 4th 2020, these procedures are
still applied in our Department while this work is being written
(10th March).