The Italian Job.

Top Line: ASTRO journals are rapidly disseminating global radiation oncology experiences in countries hit hardest thus far by the COVID-19 pandemic.

The Studies: First up, a northern Italian story. The intro reads like a movie script, detailing logarithmic spread throughout the region starting with patient zero. It then gets into the nitty-gritty of policy changes, such as establishing a single entryway into the rad onc facility where every entrant is screened for fever and respiratory symptoms then invited to wash their hands and don a surgical mask. Importantly, no new consults or treatments have been cancelled though all follow-up visits have been replaced with nursing calls. Interestingly, physicists are postponing any non-urgent (i.e. “annual”) QA and expanding their role to assist with organ support systems. An important lesson learned is establishing a firm a priori policy for how to handle patients who test positive—don’t start treatment? Interrupt treatment? Another correspondence from Italy mirrors many of these recs, specifically outlining what to do for test-positive patients—namely hold treatment until infectious period is over, except in the most extreme need. It also offers a contingency plan for severe staff shortages, including employing the shortest fractionation schemes possible and recruiting help from external radiation facilities or recent retirees.

TBL: Globally sharing lessons learned as we go will be an important component of efficiently adapting to pandemic conditions. | Krengli, Adv Radiat Oncol 2020 & Filippi, Int J Radiat Oncol Biol Phys 2020