Acute and late toxicities of patients infected with SARS-CoV-2 and treated for cancer with radiation therapy during the COVID-19 pandemic

Abstract

Purpose

This study aimed to assess the risk of acute and late radiation-induced toxicity in patients with COVID-19.

Material and methods

All the patients irradiated in Institut Curie from March to July 2020 were included if the first symptoms related to COVID-19 occurred no more than two months before the start of radiation therapy (RT) or 15 days after the end of RT.

Results

Twenty-nine patients were included in this analysis. Twenty-five patients had no co-morbidities (86.2%), including morbid obesity. The diagnosis of COVID-19 infection was based on a positive SARS-CoV-2 RNA test for 18 patients (62.1%), a positive serology test for three patients (10.3%), and/or radiologic findings for 12 patients (41.4%). Three patients with symptoms highly suggestive of COVID-19 were included, although they had negative biologic tests and did not have a chest CT scan. Median time from the diagnosis of COVID-19 to the onset of RT was 5.5 days. Modification of RT course due to COVID-19 status was observed in 15 patients, including four for whom RT was definitively stopped. Six patients needed hospitalization for hypoxemic lung disease requiring intensive care. The majority of patients did not experience severe (> grade 2) acute toxicity. After a median follow-up of 6 months (IQR, 1–9 months), none of the patients had unusual clinical or radiological late toxicities.

Conclusion

The observed acute and late toxicities were ultimately similar to those observed in a population not infected with COVID-19. These results do not prompt modification of standard RT protocols for irradiation of COVID-19 patients.

Keywords:

• COVID-19
• SARS-CoV-2 infection
• radiotherapy
• tolerance

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data generated and analyzed during this study are included in this published article (and its supplementary information files).

Additional information

Notes on contributors

Arnaud Beddok

Arnaud Beddok, MD, MSc is attending physician in the department of radiation oncology of the Institut Curie.

Marion Chevrier

Marion Chevrier, MSc. is is statistician in the statistics department of the Institut Curie.

Valentin Calugaru

Valentin Calugaru, MD, PhD. is deputy head of department and physician, specialist in the treatment of head and neck cancers, in the radiotherapy department of the Institut Curie.

Mathieu Minsat

Mathieu Minsat, MD. is deputy head of department and physician, specialist in the treatment of gynecological cancers, in the radiotherapy department of the Institut Curie.

Rémi Dendale

Rémi Dendale, MD. is deputy head of department and physician, specialist in the treatment of ophthalmological cancers, in the radiotherapy department of the Institut Curie.

Olivier Lantz

Olivier Lantz, MD, PhD. is the leader of the team "INNATE LIKE AND CD4+ T CELLS IN CANCER", in the cancer immunology department of the Institut Curie. He managed the implementation of biological tests for the diagnosis of COVID-19 in the Institut Curie.

Vincent Servois

Vincent. Servois, MD. is physician in the department of radiology of the Institut Curie. He managed the implementation of radiological diagnosis of COVID-19 in the Institut Curie.

Xavier Paoletti

Xavier Paoletti, MD, PhD. is professor of statistics in the UVSQ and statisician is the department of statistics of the Institut Curie.

Gilles Crehange

Gilles Crehange, MD, PhD. is professor of radiation oncology and the head of radiation oncology department of Institut Curie. He is specialist in the treatment of urological and digestive cancers.