Patterns of Pretreatment Diagnostic Assessment in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Non-Small Cell Lung Cancer (NSCLC): Special Characteristics in the COVID Pandemic and Influence on Outcomes.

Felix-Nikolai Oschinka Jegor Habermann,Thomas Failing,Leif Hendrik Dröge,Daniela Schmitt,Niklas Josua Alt,Stefan Rieken,Laura Anna Fischer,David Alexander Ziegler,Markus Anton Schirmer,Rami A El Shafie,Martin Leu,Andrea Hille,Manuel Guhlich,Jann Fischer,Julian Muster,Sandra Donath

doi:10.3390/curroncol29020092

Felix-Nikolai Oschinka Jegor Habermann, Thomas Failing + Show 14 more

Open Access

https://doi.org/10.3390/curroncol29020092

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Abstract

The pandemic raised a discussion about the postponement of medical interventions for non-small cell lung cancer (NSCLC). We analyzed the characteristics of pretreatment diagnostic assessment in the pandemic and the influence of diagnostic assessment on outcomes. A total of 96 patients with stereotactic body radiation therapy (SBRT) for NSCLC were included. The number of patients increased from mean 0.9 (2012–2019) to 1.45 per month in the COVID era (p < 0.05). Pandemic-related factors (contact reduction, limited intensive care unit resources) might have influenced clinical decision making towards SBRT. The time from pretreatment assessment (multidisciplinary tumor board decision, bronchoscopy, planning CT) to SBRT was longer during the COVID period (p < 0.05). Reduced services, staff shortage, or appointment management to mitigate infection risks might explain this finding. Overall survival, progression-free survival, locoregional progression-free survival, and distant progression-free survival were superior in patients who received a PET/CT scan prior to SBRT (p < 0.05). This supports that SBRT guidelines advocate the acquisition of a PET/CT scan. A longer time from PET/CT scan/conventional staging to SBRT (<10 vs. ≥10 weeks) was associated with worse locoregional control (p < 0.05). The postponement of diagnostic or therapeutic measures in the pandemic should be discussed cautiously. Patient- and tumor-related features should be evaluated in detail.

Highlights

Lung cancer is the most frequent cause of cancer death worldwide [1]
We found that the time from pretreatment assessment to the initiation of stereotactic body radiation therapy (SBRT) was longer during the COVID period
The clinical example (Figure 5) of a patient who received conventional staging and experienced nodal progression after a very short period of 2 months illustrates the relevance for this patient population. This supports that SBRT guidelines advocate the acquisition of a PET/computed tomography (CT) scan prior to SBRT due to the prognostic relevance and to minimize the risk of under-treating patients [10,12,13]

Summary

Introduction

Lung cancer is the most frequent cause of cancer death worldwide [1]. In 2020, the disease resulted in 1.8 million deaths worldwide [1]. A relevant proportion of the non-small cell lung cancer (NSCLC) patients cannot undergo surgical resection, either due to comorbidities or due to patient refusal [5]. In these patients, stereotactic body radiation therapy (SBRT) represents a therapeutic option [5,6]. The pretreatment diagnostic procedures and treatment delivery are discussed in detail [10,11,12,13] These aspects include the indications for less-invasive (e.g., cranial magnetic resonance imaging (cMRI) scan or positron emission tomography/computed tomography (PET/CT) scan) and more-invasive staging procedures (e.g., endoscopic examination) [10,12,13].

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Discussion

Conclusion