Better stay the course.

Top Line: Lung cancer isn’t breast or prostate cancer., even in a pandemic

The Study: Here’s a well-done ASTRO/ESTRO consensus on the best ways to move forward with radiation treatments of six common presentations of non-small (NSCLC) and small cell lung cancer (SCLC) in either of two scenarios: (1) early pandemic where the goal is risk mitigation via minimizing patient and staff exposure and (2) late pandemic where there are limited resources. There was strong consensus to delay radiation start for post-op NSCLC and prophylactic cranial irradiation (PCI) for SCLC, split decision to delay stereotactic treatment (SBRT) for early-stage NSCLC, and strong consensus not to delay start for definitive treatments for advanced NSCLC and limited stage (LS)-SCLC nor for palliating symptomatic thoracic disease. In early pandemic, there was also strong consensus to avoid straying from conventional fractionation for advanced NSCLC, LS-SCLC or PCI. However, most agreed to embrace 30-34 Gy x 1 for early-stage peripheral NSCLC as well as 4 Gy x 5, 8.5 Gy x 2, or 8-10 Gy x 1 for palliation of thoracic disease. In late pandemic, with your back against the wall, there are further recs for hypofractionation schemes for everything except post-op treatment and PCI (maybe just don’t do that last one..?). Finally, there was consensus to hold treatment for COVID-19(+) patients, and there’s a nice summary of how to triage cases in late pandemic.

TBL: We only skimmed the surface with this one so it deserves a bookmark if you anticipate radiating lung cancer in the coming weeks to months. | Guckenberg, Radiother Oncol 2020