In accordance with guidelines published during the first wave of the COVID-19 pandemic, changes in lung cancer management were made in the UK that most often included altered radiotherapy fractionation, the omission or reduction of chemotherapy, and the provision of radiotherapy in lieu of surgery. These findings were presented at the European Lung Cancer Virtual Congress 2021 (25-27 March) by Kathryn Banfill of the The Christie NHS Foundation Trust, Manchester, UK.
She explained that the COVID-RT Lung study described the changes that were adopted across the UK following the publication of the COVID-19 pandemic guidelines on reduced fractionation for patients with lung cancer treated with curative-intent radiotherapy.1 These guidelines aimed to reduce the number of hospital attendances to limit potential exposure of vulnerable patients to SARS-CoV-2.
COVID-RT Lung is a prospective multicentre UK data collection that includes patients with stage I to III lung cancer (biopsy-proven or diagnosed on cross-sectional imaging) that were referred for and/or treated with radical radiotherapy from 2 April 2020 to 2 October 2020. Every participating centre obtained local approval and anonymised data were collected on a central, cloud-based Research Electronic Data Capture system.
Data collection included patients with a change in disease management as well as those who continued with standard management. The data collected included demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment, treatment-related toxicity, and disease/patient status.
Among the 20 UK radiotherapy sites reporting, there were records from 1117 patients with stage I-III lung cancer that were available for analysis on 30 November 2020. Of these, 562 (50%) patients were female with a median age of 72 years (range, 38 to 93) years. COVID-19 had been diagnosed in 15 (1%) patients, with 9 diagnoses occurring prior to radiotherapy.
Changes in management were most often implemented in patients with better ECOG performance status
Due to the pandemic, 160 (14%) patients had their diagnostic investigations affected and 415 (37%) patients had their treatment changed from their centre’s standard of care.
Of the patients with changes in treatment, 210 received a different radiotherapy dose or fractionation and 86 patients were treated with radiotherapy instead of surgery. The patients with a radiotherapy dose/fractionation change received a median of 15 radiotherapy fractions compared to 20 fractions for those who were treated as per standard of care.
Chemotherapy was omitted in 87 patient and reduced in 56 patients. Immunotherapy was omitted or reduced in 6 patients and prophylactic cranial irradiation was omitted in 4 patients. A watch and wait regimen was instituted for 24 patients and 3 patients received no treatment.
Dr. Banfill and co-investigators determined that patients with ECOG performance status (PS) 0-1 were more likely to have their treatment changed compared to patients with a poorer PS.
The authors concluded that data from this nationwide cohort shows that clinicians in the UK changed the management of patients with stage I-III lung cancer in line with national COVID-19 guidelines.
They noted that the primary changes were a reduction in chemotherapy use and an increase in radiotherapy hypofractionation. The data collection for COVID-RT Lung is ongoing including data on outcomes of patients treated during the pandemic. This will help to determine the effect of these changes on cancer recurrence and patients’ survival.
This study was funded by the Biomedical Research Centre, Manchester.
- Faivre-Finn C, Fenwick JD, Franks KN, et al. Guidelines Reduced Fractionation in Lung Cancer Patients Treated with Curative intent Radiotherapy during the COVID-19 Pandemic. Clinical Oncology 2020;32:481-489. DOI: https://doi.org/10.1016/j.clon.2020.05.001
203MO – Banfill K, Price G, Wicks K, et al. Changes in management for patients with lung cancer treated with radical radiotherapy during the first wave of the COVID-19 pandemic in the UK (COVID-RT Lung). European Lung Cancer Virtual Congress 2021 (25-27 March).