No added risks to radiation therapy for cancer patients with COVID-19, says study

Some are especially vulnerable to severe coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These include the elderly, people with comorbidities like hypertension, heart disease, diabetes, and obesity, and those with weakened immune systems, such as cancer patients undergoing treatment.

Most studies have tackled more on the vulnerability of people with underlying health conditions. There are limited studies about how coronavirus infection impacts cancer patients undergoing treatment, including chemotherapy and radiation.

A team of radiation oncologists at the Zucker School of Medicine at Hofstra/Northwell in the United States aimed to determine if COVID-19 infected cancer patients receiving radiation therapy (RT) have any different outcome than non-infected patients.

They found that there is no direct added toxicity during COVID-19 infection, but long-term data are pending.

The study

The team conducted a case study in the journal Cureus, involving cancer patients undergoing radiation therapy. The study explores the experience from the epicenter of the pandemic in treating COVID-19 positive patients with RT.

The researchers collected data through the ONCORA d data collection system, which was integrated with electronic medical records to arrive at the study findings.

Case 1

The first case was a 76-year-old female who was newly diagnosed with stage IIA cervical clear cell adenocarcinoma. The patient had a large cervical mass, measuring 10 cm. In February 2020, the patient had her first RT consult due to vaginal bleeding and underwent radiation therapy.

During the radiation therapy treatment, the patient began showing difficulty breathing, with an oxygen saturation of 88 percent. The procedure was withheld, and the patient underwent COVID-19 testing, which turned out positive.

As a result, the patient was hospitalized and developed abdominal distension and perforation. After developing pulmonary symptoms, the patient died without completing her RT.

Case 2

The second case was a 70-year-old female who has unresectable squamous cell carcinoma of the vulva. The patient noted she had a painful vulvar bump, and after several scans, the doctor recommended RT. The patient started her treatment in March 2020 for five days. When she returned to therapy in April 2020, she was diagnosed with COVID-19 after developing shortness of breath.

Overnight, the patient’s oxygen saturation dropped, and the doctors restarted the RT treatment. However, it was interrupted due to inadequate nursing care at the facility, and she decided to stop the treatment.

Case 3

The third case was a 65-year-old female with stage IV endometrial carcinoma with sarcomatoid features. The patient was admitted to the hospital between April and May 2020.

The patient’s cancer has already spread, and given her metastatic disease, palliative chemotherapy was proposed. The patient has undergone an RT course, but while being treated, she developed a cough. She was eventually diagnosed with COVID-19. Despite this, she completed the RT course without complications and problems.

Case 4

The last case was a 76-year-old male with prostate cancer. He received pelvic RT for his illness and had metastatic disease in 2015. In January 2020, he received his second RT course. Five months after, he tested positive with COVID-19 during a hospital admission due to back pain. The patient finished his RT treatment and responded with improved pain control. There were no adverse effects of RT.

Study implications

The study presented four cases of cancer patients who were subsequently diagnosed with COVID-19 and received RT. The researchers noted that these patients had outcomes that do not seem to be affected by the viral infection.

In fact, the patients had no acute and unexpected adverse effects of RT. The researchers noted that the case study was the first to report COVID-19 infected cancer patients treated with RT.

The team concluded that there is no direct added toxicity during COVID-19 infection among cancer patients undergoing RT. This means that it is safe to continue with the treatment. However, the team also recommends for future prospective studies using RT in COVID-19 patients.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Angela Betsaida B. Laguipo

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.

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