Advances in Radiation Oncology Rapid Adaptation of Breast Radiotherapy Utilization during the COVID-19 Pandemic at a Large Academic Cancer Centre in Canada --Manuscript Draft-- Manuscript Number: ADVANCESRADONC-D-20-00231 Article Type: Scientific Article Section/Category: COVID-19 Corresponding Author: Christine Anne Koch Princess Margaret Cancer Centre Toronto, Ontario CANADA First Author: Christine Anne Koch Order of Authors: Christine Anne Koch Grace Lee Zhihui Amy Liu Fei-Fei Liu Anthony Fyles Kathy Han Aisling Barry Jennifer Croke Danielle Rodin Joelle Helou Ezra Hahn Naghmeh Isfahanian Jane DeRocchis Susanne Lofgren Thomas Purdie Abstract: Background: Mitigation strategies to balance the risk of COVID-19 infection against oncologic risk in breast cancer patients undergoing radiotherapy have been deployed. To this end, shorter hypofractionated regimens have been recommended where appropriate, with prioritization of radiotherapy by oncologic risk and omission or deferral of radiotherapy for lower risk cases. Timely adoption of these measures reduces COVID-19 risk to both patients and health care workers, and preserves resources. Herein we present our early response and adaptation of breast radiotherapy utilization during the COVID-19 pandemic at a large academic cancer centre in Canada. Methods : A state of emergency was announced in Ontario on March 17, 2020 due to the COVID-19 pandemic. Emergency guidelines were instituted. To examine our response, the number of weekly breast RT starts, type of breast RT, and patient age were compared from March 1 to April 30, 2020 to the same period in 2019. Results: Following the declaration of emergency in Ontario, there was a decrease of 39% in radiotherapy starts in 2020 compared to 2019 (79 vs . 129, p<0.001). There was a relative increase in the proportion of patients receiving regional nodal irradiation (RNI) in 2020 compared to 2019 (46% vs . 29%, respectively), with the introduction of hypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patients starting radiotherapy were aged > 50 years in 2020, 66% (78/118) vs . 83% (132/160) in 2019, p=0.0027. Conclusions : A significant reduction in breast radiotherapy starts was noted during the early response to the COVID-19 pandemic, with prioritization of radiotherapy to patients associated with higher oncologic risk requiring RNI. A quick response to a Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
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Advances in Radiation Oncology
Rapid Adaptation of Breast Radiotherapy Utilization during the COVID-19 Pandemic ata Large Academic Cancer Centre in Canada
--Manuscript Draft--
Manuscript Number: ADVANCESRADONC-D-20-00231
Article Type: Scientific Article
Section/Category: COVID-19
Corresponding Author: Christine Anne KochPrincess Margaret Cancer CentreToronto, Ontario CANADA
First Author: Christine Anne Koch
Order of Authors: Christine Anne Koch
Grace Lee
Zhihui Amy Liu
Fei-Fei Liu
Anthony Fyles
Kathy Han
Aisling Barry
Jennifer Croke
Danielle Rodin
Joelle Helou
Ezra Hahn
Naghmeh Isfahanian
Jane DeRocchis
Susanne Lofgren
Thomas Purdie
Abstract: Background: Mitigation strategies to balance the risk of COVID-19 infection againstoncologic risk in breast cancer patients undergoing radiotherapy have been deployed.To this end, shorter hypofractionated regimens have been recommended whereappropriate, with prioritization of radiotherapy by oncologic risk and omission ordeferral of radiotherapy for lower risk cases. Timely adoption of these measuresreduces COVID-19 risk to both patients and health care workers, and preservesresources. Herein we present our early response and adaptation of breastradiotherapy utilization during the COVID-19 pandemic at a large academic cancercentre in Canada.Methods : A state of emergency was announced in Ontario on March 17, 2020 due tothe COVID-19 pandemic. Emergency guidelines were instituted. To examine ourresponse, the number of weekly breast RT starts, type of breast RT, and patient agewere compared from March 1 to April 30, 2020 to the same period in 2019.Results: Following the declaration of emergency in Ontario, there was a decrease of39% in radiotherapy starts in 2020 compared to 2019 (79 vs . 129, p<0.001). Therewas a relative increase in the proportion of patients receiving regional nodal irradiation(RNI) in 2020 compared to 2019 (46% vs . 29%, respectively), with the introduction ofhypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patientsstarting radiotherapy were aged > 50 years in 2020, 66% (78/118) vs . 83%(132/160) in 2019, p=0.0027. Conclusions : A significant reduction in breast radiotherapy starts was noted duringthe early response to the COVID-19 pandemic, with prioritization of radiotherapy topatients associated with higher oncologic risk requiring RNI. A quick response to a
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health care crisis is critical, and is of particular importance for higher volume cancersites where the potential impact on resources is greater.
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Rapid Adaptation of Breast Radiotherapy Utilization during the COVID-19 Pandemic at a Large
Academic Cancer Centre in Canada
CA Koch MD, PhD1,2, G Lee1,2, ZA Liu PhD3,4, F-F Liu MD1,2, A Fyles MD1,2, K Han MD1,2, A Barry MD1,2, J
Croke MD1,2, D Rodin MD1,2, J Helou MD1,2, E Hahn MD1,2, N Isfahanian MD1,2, J DeRocchis1, S Lofgren1, TG
Purdie, PhD1,2
1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 700
University Avenue, Toronto, Ontario, Canada M5G 1Z5
2Department Radiation Oncology, University of Toronto, Ontario, Canada
3Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto,
Ontario, Canada
4Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
Running title: Breast Radiotherapy during COVID-19 Pandemic
Corresponding author: Dr. C. Anne Koch, MD, PhD, FRCPC
Princess Margaret Cancer Centre, University Health Network
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