This is a multicenter cohort study of 105 cancer patients and 536 age-matched patients without cancer using data collected from 14 hospitals in Hubei Province, China, the epicenter of the COVID-19 outbreak. They analyzed the patients for clinical characteristics and outcomes. They found that COVID-19 patients with cancer had higher risks in all severe outcomes, with the highest frequency of severe outcomes in patients with hematologic cancer, lung cancer, or metastatic cancer. Patients who received surgery also had higher risks of severe events. In general patients with cancer and COVID-19 had nearly a 3-fold increase in the death rate compared to COVID-19 patients without cancer, and also tended to have more severe illness. However, patients who received radiation therapy did not show significant differences in severe events when compared to the patients without cancer.  

These findings do provide early clinical evidence that cancer patients with COVID-19 are at high risk of severe outcomes compared to noncancer patients and supports the notion that effective protective measures are of great importance for this patient population. 

(Open Access)

Reference (PubMed Link): Dai M, Liu D, Liu M, et al. Patients with cancer appear more vulnerable to sars-cov-2: A multicenter study during the covid-19 outbreak. Cancer Discov 2020;10:783-791.

Key Institution: Hubei Cancer Clinical Study Center
Keywords: COVID-19, cancer patients 

This article notes that the clinical spectrum of COVID19 ranged from asymptomatic to acute respiratory distress syndrome (ARDS) and sequential organ failure (SOF) as a result of cytokine storm. ARDS requires supplemental oxygen and mechanical ventilator support; despite these measures, mortality is high for patients with severe disease. 

The article reviews the pathogenesis of COVID-19 and describes in some detail the effects of a hyperinflammatory state caused by the virus. It also provides some historical prior studies including a 2013 review of low dose radiation therapy to treat pneumonia during the 20th century; this review reported that about 700 patients with pneumonia were effectively treated with low-dose RT. The present paper reviewed that radiation therapy can induce an anti-inflammatory response that could theoretically be achieved with low doses of radiation therapy (0.3-0.5 Gy in a single fraction).

This article was certainly interesting and provided some historical context that radiation therapy has been used to treat pneumonias in the past, although the quality of evidence is quite low by modern standards and at best this review is hypothesis-generating. More specific preclinical work should be done.

(Open Access)

Reference (PubMed Link): Dhawan G, Kapoor R, Dhawan R, et al. Low dose radiation therapy as a potential life saving treatment for covid-19-induced acute respiratory distress syndrome (ards). Radiother Oncol 2020;147:212-216.

Key Institution: University of Massachusetts
Keywords: Radiation Therapy, COVID-19, ARDS 

SARS-CoV-2, the virus that causes COVID-19, has been responsible for nearly 500,000 deaths worldwide. Prior studies have shown that patients with comorbidities who develop COVID-19 have a higher risk of poor outcomes. Some studies have shown that patients with malignancy, in particular, are at-risk.

The authors of this study retrospectively examined patients who tested positive for COVID-19 and had previously received radiation therapy for malignancy between March 14, 2020 and April 15, 2020 at Montefiore Medical Center. They identified 107 patients: 26% had malignancies of the breast, 25% prostate, 13% lung, 7% gynecologic, 6% head and neck, 4% blood, and 21% other. The primary study outcome was overall survival from the time of the positive COVID-19 test.

The median follow-up was 7 days from the date of diagnosis for patients alive with COVID-19. 24 patients had passed away at the time of the analysis. The actuarial 14-day survival rate was 66%. Increasing mean lung dose, a diagnosis of lung cancer, and having receiving radiation therapy one month and one year before the positive COVID-19 test were all linked to a higher risk of death. The authors noted that their “survival model demonstrates a near linear relationship between mortality risk after COVID-19 diagnosis and mean lung radiation therapy dose.”

In sum, in this single institution retrospective study, the authors found that patients with a history of radiation therapy who were diagnosed with COVID-19 had a 66% 14-day actuarial survival. The authors also found a nearly linear relationship between mean lung dose from radiation therapy and mortality after being diagnosed with COVID-19. However, these results be must be further validated before drawing more generalized conclusions.

(Open Access)

Reference (PubMed Link): Kabarriti R, Brodin NP, Maron MI, et al. Extent of prior lung irradiation and mortality in covid-19 patients with a cancer history. Adv Radiat Oncol 2020;5:707-710.

Key Institution: Montefiore Medical Center
Keywords: COVID-19, Lung Irradiation, mortality

In this short article, authors from two Italian hospitals described the use of simulation CT for detecting abnormal lung findings that suggest a possible COVID-19 infection. Essentially, for patients who are treated in the thoracic area, the treating radiation oncologists would read the sim-CT and, if a suspicious COVID-19 lung pattern was found, the scan would be evaluated by a diagnostic radiologist. After confirmation by Radiology, the patients were screened with throat swabs. At the time of the publication, 101 sim-CTs were read, and 4 patients have been considered highly suspicious of COVID-19. Fortunately, none were diagnosed with COVID-19.

(Open Access)

Reference (PubMed Link): Vitullo A, De Santis MC, Marchianò A, et al. The simulation-ct: Radiotherapy's useful tool in the race against covid-19 pandemic. A serendipity approach. Radiother Oncol 2020;147:151-152.

Key Institution: Multi-institutional in Italy
Keywords: COVID-19, simulation CT

A panel of 30 international experts completed a modified rapid Delphi process.  

Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. Specific challenges were identified for patients with HNC: (1) operating room closures leading to increased nonsurgical treatments; (2) altered risk-benefit ratio of chemotherapy and radiation therapy due to increased susceptibility for SARS-CoV-2 infection; (3) a need to suppress SARS-CoV-2 spread by minimizing patient travel and staff exposure; and (4) a potential shortage of radiation therapy resources because of staff sickness. The panel developed treatment recommendations for 5 common head and neck cancer (HNC) cases: oropharynx cancer, early stage larynx cancer, advanced larynx cancer, hypopharynx cancer, and oral cavity cancer. No changes to standard fractionation schedules were favored in early pandemic (risk mitigation), while there was strong agreement to the use of hypofractionation schedules in late pandemic (shortage of radiation therapy resources). 

(Open Access)

Reference (PubMed Link): Thomson DJ, Palma D, Guckenberger M, et al. Practice recommendations for risk-adapted head and neck cancer radiation therapy during the covid-19 pandemic: An astro-estro consensus statement. Int J Radiat Oncol Biol Phys 2020;107:618-627.

Key Institution:  Multi-Institutional (ASTRO-ESTRO)
Keywords: Covid-19, radiation oncology