PO-0951 Effects of COVID-19 during radio(chemo)therapy in head and neck cancer patients

Abstract

Purpose or Objective To evaluate effects of COVID-19 during (chemo)radiation (RT) or quarantine on overall treatment time and outcome, as well as to determine prognostic parameters for COVID-19 related death in patients with head and neck cancer (HNC). Materials and Methods We have performed a retrospective review and identified patients with confirmed SARS-CoV-2 or quarantine during RT of HNC, who were treated in 3 radiotherapy departments from March 2020 till February 2021. The quarantine was imposed due to a close contact with COVID-19 positive person e.g. after hospitalisation in the same patient's room. Univariate analysis was performed using a Cox proportional hazards model for COVID-19 positive patients. The covariates included were age, co-morbidities, smoking, white blood cell (WBC) ratio measured on the day of positive COVID-19 test result divided by WBC count taken one week before, C-reactive protein (CRP) ratio, which was obtained analogically to WBC ratio. WBC-ratio and CRP-ratio were chosen to reflect dynamics of possible changes in inflammatory parameters. Results 36 patients (pts) were included in the analysis. Mean age yield 66 years (Range: 25-87). 92% of pts, were treated with curative intent. Two patients had induction chemotherapy and 9 pts got simultaneous chemoradiation. The median follow-up was 3.4 month (Range: 1-5.6). In total 7 patients died, 5 of them were categorised as COVID-19 related death. The time lapsed from a COVID-19 positive test result to death varied in these 5 pts from 8 to 17 days. 26 (72%) pts had SARS-CoV-2 infection confirmed and in the case of 10 pts RT was interrupted due to imposed quarantine. The median interruption time of RT yield 20 days (13-65) and 14 days (10-19) due to COVID-19 and quarantine, respectively. 36% patients did not continue RT due to various reasons including death (5 pts) and deterioration of performance status (3 pts). We did not observe a significant correlation between age, hypertension, performance status, intention to treat (primary vs adjuvant vs palliative), smoking, number of RT fractions before COVID-19 infection, ischaemic heart disease, pulmonary disease, uncontrolled diabetes and risk of COVID-19 related death on univariate Cox analysis. However, in a subgroup of patients (n=17) with available regular blood analysis data WBC-ratio correlated significantly with risk of COVID-19 related death (p=0.02). CRP-ratio did not show significance for risk of COVID-19 related death (p=0.12). By the time of 3 month follow-up one patient treated with palliative intention progressed and died. Conclusion COVID-19 infection extended overall treatment time in median for 20 days. From radiobiological point of view this is a substantial prolongation, thus these patients are at higher risk of recurrence and demand careful follow-up. In our subgroup of patients WBC-ratio was prognostic for risk of COVID-19 related death. Due to low number of patients this observation should be validated in a larger cohort of patients.