Changes in the management of patients having radical radiotherapy for lung cancer in the UK during the COVID-19 pandemic (COVID-RT Lung)


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Kathryn Banfill, Gareth Price, Kate Wicks, Dila Mokhtar, Keith Harland, Andrew Brocklehurst, William Croxford, Sheena Lam, Niki Panakis, Kamalram Thippu Jayaprakash, Matthew Hatton, Ceri Powell, Corinne Faivre-Finn

Abstract

Background

In response to the COVID-19 pandemic, guidelines on reduced fractionation for patients with lung cancer treated with curative-intent radiotherapy were published, aiming to reduce hospital attendances for vulnerable patients.

Method

COVID-RT Lung is a multicentre UK audit. Inclusion criteria are: patients with stage 1–3 lung cancer referred for radical radiotherapy after 2nd April 2020. All patients are included regardless of whether a change in management was implemented. Each participating centre obtains approval from their local data protection officer. Anonymised data is collected on a central, cloud-based Research Electronic Data Capture system. Currently, 35 of the UK’s 62 radiotherapy centres are registered and the audit continues to accept new sites.

Results

There were 498 records available for analysis on 8th September 2020. Median age 72 years (38-89 years), 242 (49%) female. 7 patients were diagnosed with COVID-19, 5 prior to starting radiotherapy. 49 patients (10%) had a change in their diagnostic work-up for lung cancer and 202 patients (41%) had their treatment changed from their centre’s standard of care. 56 patients (11%) had radiotherapy instead of surgery, 106 (21%) had a different radiotherapy schedule and 80 (16%) had systemic treatment omitted or altered. The radiotherapy schedules received are summarised in table below.The group of patients who did not have their treatment changed contained significantly more patients with performance status 2-3 (p<0.001, Wilcoxon signed-rank test).

Radiotherapy, fractions

Treatment changed (n=202)

No change to treatment (n=296)

SABR,1

6(3%)

0

SABR, 3

30(15%)

28(9%)

SABR, 5

21(10%)

69(23%)

SABR, 8

13(7%)

18(6%)

Concurrent chemoradiotherapy, 15

6(3%)

2(1%)

Sequential chemoradiotherapy, 15

27(13%)

5(2%)

Radiotherapy alone, 15

29(14%)

12(4%)

Concurrent chemoradiotherapy, 20

8(4%)

20(7%)

Sequential chemoradiotherapy, 20

15(8%)

42(14%)

Radiotherapy alone, 20

40(20%)

76(26%)

Concurrent chemoradiotherapy, ≥ 30

1 

7(2%)

Other

6(3%)

17(6%)


Conclusion

Initial analysis of this nationwide audit shows clinicians are changing management in line with the UK guidelines on reduced fractionation. There are fewer changes in the management of PS2-3 patients. The main change is an increase in hypofractionated and ultra-hypofractionated radiotherapy.

Impact statement

This national audit provides evidence of the impact of COVID-19 on lung cancer radiotherapy and future work will link treatment changes with patient outcome.