Muzaffer Bedri ALTUNDAĞ, Can AZAK, Gülçin ERTAŞ, Cafer ATAR

Breast cancer patients with delayed radiotherapy during the pandemic process

Aim: In this study; We wanted to examine the changes and delays in radiotherapy of all our breast cancer patients diagnosed with COVID-19 Material and Method: Radiotherapy delays of our breast cancer patients who had COVID-19 infection before and during radiotherapy between March 2020 and March 2021 were evaluated retrospectively. Results: Sixteen of a total of 642 breast cancer patients, 472 operated and 165 metastatic, who underwent radiotherapy were diagnosed with COVID-19. All patients were women, ages were between 40 and 77 (mean 54.6). Five patients had a mastectomy, 8 had breast-conserving surgery, and 3 had breast cancer with bone metastases. Different radiotherapy schemes were applied at different treatment duration according to the clinical stage and disease status. The first breast cancer patient with COVID-19 infection was diagnosed on 27 June 2020. Our other patients were diagnosed from June to December (n=15) in 2020. Treatment of patients infected during radiotherapy was interrupted after a mean of 10 fractions (2-24 fractions) and treatment was started after a mean of 25 days (21-44 days). Post-operative patients who could not start treatment because they were SARS-CoV-2 PCR positive were able to start treatment after a mean of 22 days (14-30 days). Conclusion: Radiotherapy could not be started at the recommended times for breast cancer patients infected with COVID-19 during the pandemic and the treatments had to be interrupted. Therefore, more care should be taken in the follow-up of these patients; should be considered as patients at risk for local recurrence and metastasis.

Keywords:

Breast Cancer, Radiotherapy, COVID-19, Pandemic,

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Richards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer 2020: 1-3.
Lee S, Heo J. COVID-19 pandemic: a new cause of unplanned interruption of radiotherapy in breast cancer patients. Med Oncol 2021; 39: 5.
Papautsky EL, Hamlish T. Patient-reported treatment delays in breast cancer care during the COVID-19 pandemic. Breast Cancer Res Treat 2020; 184: 249-54.
Bese NS, Hendry J, Jeremic B. Effects of prolongation of overall treatment time due to unplanned interruptions during radiotherapy of different tumor sites and practical methods for compensation. Int J Radiat Oncol Biol Phys 2007; 68: 654-61.
Coles CE, Aristei C, Bliss J, et al. International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32: 279-81.
Göksel F, Güzle Adaş Y. Management of a radiation oncology clinic in a clean oncology hospital during the COVID-19 outbreak. J Surg Med 2020; 4: 925-9.
Anacak Y, Onal C, Ozyigit G, et al. Changes in radiotherapy practice during COVID-19 outbreak in Turkey: A report from the Turkish Society for Radiation Oncology. Radiother Oncol 2020; 150: 43-5.
Marschner S, Corradini S, Rauch J, et al. SARS-CoV-2 prevalence in an asymptomatic cancer cohort-results and consequences for clinical routine. Radiat Oncol 2020; 15: 165.
Ning MS, McAleer MF, Jeter MD, et al. Mitigating the impact of COVID-19 on oncology: Clinical and operational lessons from a prospective radiation oncology cohort tested for COVID-19. Radiother Oncol 2020; 148: 252-7.
Benk V, Joseph L, Fortin P, et al. Effect of delay in initiating radiotherapy for patients with early stage breast cancer. Clin Oncol (R Coll Radiol) 2004; 16: 6-11.
Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJJJoco. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review 2003; 21: 555-63.
Bese NS, Sut PA, Ober A. The effect of treatment interruptions in the postoperative irradiation of breast cancer. Oncology 2005; 69: 214-23.
Gemici C, Yaprak G. Covid-19 outbreak in a major radiation oncology department; which lessons should be taken? Radiother Oncol 2020; 149: 107-8.
Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 2013; 14: 1086-94.
Brunt AM, Haviland JS, Sydenham M, et al. Ten-year results of FAST: a randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer. J Clin Oncol 2020; 38: 3261-72.
Brunt AM, Wheatley D, Yarnold J, et al. Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3-week regimen delivered in the UK FAST-Forward Trial. Radiother Oncol 2016; 120: 114-8.
de Azambuja E, Trapani D, Loibl S, et al. ESMO Management and treatment adapted recommendations in the COVID-19 era: Breast Cancer. ESMO Open 2020; 5.
Lutz ST, Chow EL, Hartsell WF, Konski AA. A review of hypofractionated palliative radiotherapy. Cancer 2007; 109: 1462-70.
Tsoutsou PG, Koukourakis MI, Azria D, Belkacemi Y. Optimal timing for adjuvant radiation therapy in breast cancer: a comprehensive review and perspectives. Crit Rev Oncol Hematol 2009; 71: 102-16.
Abdel-Rahman O. Impact of timeliness of adjuvant chemotherapy and radiotherapy on the outcomes of breast cancer; a pooled analysis of three clinical trials. Breast 2018; 38: 175-80.