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 .