TY - JOUR
T1 - Radiation Fractionation Schedules Published During the COVID-19 Pandemic
T2 - A Systematic Review of the Quality of Evidence and Recommendations for Future Development
AU - Thomson, David J.
AU - Yom, Sue S.
AU - Saeed, Hina
AU - El Naqa, Issam
AU - Ballas, Leslie
AU - Bentzen, Soren M.
AU - Chao, Samuel T.
AU - Choudhury, Ananya
AU - Coles, Charlotte E.
AU - Dover, Laura
AU - Guadagnolo, B. Ashleigh
AU - Guckenberger, Matthias
AU - Hoskin, Peter
AU - Jabbour, Salma K.
AU - Katz, Matthew S.
AU - Mukherjee, Somnath
AU - Rembielak, Agata
AU - Sebag-Montefiore, David
AU - Sher, David J.
AU - Terezakis, Stephanie A.
AU - Thomas, Toms V.
AU - Vogel, Jennifer
AU - Estes, Christopher
N1 - Funding Information:
A.C., D.J.T., and P.H. are supported by NIHR Manchester Biomedical Centre . C.E.C. is supported by NIHR Cambridge Biomedical Centre . D.J.T. is supported by a grant from the Taylor Family Foundation and Cancer Research UK . S.M. is partly supported by the NIHR Oxford Biomedical Center .
Funding Information:
A.C., D.J.T., and P.H. are supported by NIHR Manchester Biomedical Centre. C.E.C. is supported by NIHR Cambridge Biomedical Centre. D.J.T. is supported by a grant from the Taylor Family Foundation and Cancer Research UK. S.M. is partly supported by the NIHR Oxford Biomedical Center. Disclosures: S.T.C. reports personal fees from Varian Medical Systems, outside the submitted work. A.C. reports grants from the National Institute of Health Research, Manchester Biomedical Research Centre, Cancer Research, UK, Medical Research Council, UK, Prostate Cancer, UK, and Bayer, UK; personal fees from Janssen Pharmaceutical; nonfinancial support from ASCO; and grants and nonfinancial support from Elekta AB, outside the submitted work. I.E.N. reports grants from the National Institutes of Health, Endectra LLC, and Resero AI LLC, outside the submitted work. C.E. reports other from Novocure, outside the submitted work. M.G. reports grants from Varian and AstraZeneca and personal fees from AstraZeneca, outside the submitted work. M.S.K. owns common stock in Dr Reddy's Laboratories, Healthcare Services Group, Mazor Robotics, and U.S. Physical Therapy. S.K.J. reports grants, personal fees, and nonfinancial support from Merck & Co, outside the submitted work. S.S.Y. reports grants from Genentech, Bristol-Myers Squibb, Merck, and BioMimetix and personal fees from Springer and UpToDate, outside the submitted work.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Purpose: Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. Methods and Materials: Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. Results: From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19–adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = 0.022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence “pre-COVID” vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. Conclusions: A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.
AB - Purpose: Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. Methods and Materials: Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. Results: From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19–adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = 0.022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence “pre-COVID” vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. Conclusions: A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.
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U2 - 10.1016/j.ijrobp.2020.06.054
DO - 10.1016/j.ijrobp.2020.06.054
M3 - Article
C2 - 32798063
AN - SCOPUS:85089826934
SN - 0360-3016
VL - 108
SP - 379
EP - 389
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -