key: cord-0901640-xoneu3z1 authors: Allali, Sofiane; Servois, Vincent; Beddok, Arnaud; Fourquet, Alain; Kirova, Youlia title: Evaluation of the early adverse effects of radiotherapy in breast cancer patients with COVID‐19: Prospective single institutional study date: 2021-08-25 journal: Breast J DOI: 10.1111/tbj.14282 sha: ddbb8b572fd0c140ab15dffab906f4395e17bae0 doc_id: 901640 cord_uid: xoneu3z1 The COVID‐19 caused by the SARS‐CoV‐2 coronavirus is at the origin of a global pandemic. This pandemic has prompted the current health system to reorganize and rethink the care offered by health establishments. We report the early toxicity in patients infected with COVID‐19 treated at the same time for early‐stage breast cancer (BC). This is a monocentric prospective study of patients treated in our hospital between March 2020 and June 2020 and were diagnosed with COVID‐19 infection. The inclusion criteria were to be irradiated for early‐stage BC and to have a positive COVID‐19 diagnosis on a PCR test and/or a lung computed tomography (CT) scan and/or suggestive clinical symptoms. Radiotherapy (RT) consisted of breast or chest wall irradiation with or without lymph node irradiation, with protocols adapted to pandemic situation. The treatment‐related toxicity was graded according to the CTCAE (version 4.03). All 350 patients treated for early‐stage BC were studied. Of them, 16 were presented with clinical symptoms of COVID‐19 infection and of them, 12 had clinical, CT scan, and PCR confirmation. This entire cohort of 12 pts with median age of 56 (42–72) underwent their RT. During the radiotherapy, there were 9 pts presented radiation dermatitis, 8 (66%) were grade 1 and one was (8%) grade 2. Two patients with lymph nodes irradiation presented esophagitis grade 2. This prospective COVID‐19 cohort, treated for early‐stage BC demonstrated an acceptable toxicity profile with few low‐grade adverse events. Longer follow‐up is needed to confirm these findings. is 47 years, comprising 42% of females and 58% of males, and the mortality rate varies between 1 and 3% depending on the country. 1, 2 This pandemic has required reorganization of the current health system and a new approach to the management provided by health care facilities. New guidelines have therefore emerged to limit spread of the virus. Learned societies have issued guidelines for hygiene and barrier measures (COVID-19 arrowed pathways in health care facilities, use of masks, rubbing hands with sanitizer gel, etc.), as well as new practices in each medical or surgical specialty. New guidelines for the management of cancer patients have emerged, with a preference for oral vs. IV chemotherapy, 3-week vs. weekly regimens, home chemotherapy injections, and postponement of nonurgent care. Surgery for carcinoma in situ can therefore be delayed for 3 to 6 months and surgery for invasive ductal carcinoma can be delayed for up to 6 weeks. 3 Reorganization of radiotherapy (RT) has required the temporary suspension of time-consuming irradiation techniques, the use of hypofractionated treatment regimens, 3 the use of dedicated machines for COVID-19 patients. Many authors have questioned whether cancer is a risk factor for a severe form of COVID-19. Data in the literature on this subject remain discordant at the present time due to an underrepresentation of cancer patients in published series, preventing identification of cancer as an independent risk factor. 4 However, the literature tends to agree on a nonstatistically significant association between cancer and severe forms of COVID-19, but the comorbidities of these patients are generally considered to account for the more severe forms of COVID-19 in this population. 4 To date, no publication has evaluated the short-term effects of radiotherapy in SARS-CoV-2-infected patients treated for nonmetastatic breast cancer during the first wave of the pandemic. In this study, we therefore tried to assess the effects of radiotherapy in a prospective cohort of SARS-CoV-2-infected patients treated for breast cancer in our institution. This study, conducted on a prospective, single-center cohort, evalu- Notification of all confirmed or suspected cases of COVID-19 was made compulsory by the Director of the Institut Curie Paris. All notified patients were included in the registry on the day of notification. We consecutively registered all patients presenting symptoms suggestive of COVID-19 and/or COVID-19 confirmed by reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swabs and/or chest CT images suggestive of COVID-19. The multi-disciplinary COVID-19 patient registration group was set up to centralize and coordinate all decisions and strategies related to the COVID-19 pandemic. This study was submitted to the COVID-19 group and was approved as a prospective study to be conducted on this data base. All patients provided their oral consent for inclusion in this study. Study inclusion criteria were patients treated for nonmetastatic breast cancer at the Institut Curie Paris with a positive diagnosis of COVID-19 on RT-PCR test and/or chest CT and/or clinical symptoms (fever, dyspnea, ageusia, anosmia, etc.). The study, designed to assess radiation-related toxicity in a population of breast cancer patients treated by local-regional radiotherapy with a concomitant diagnosis of COVID-19 diagnosed during the radiotherapy, was proposed to and approved by the Institut Curie COVID-19 group scientific and ethics committee. We used dedi- Adverse effects experienced by patients during treatment were This study therefore tends to show that the initial lesions or lung sequelae associated with COVID-19 are not more severe or more prolonged after radiotherapy, in patients treated for breast cancer with proven COVID-19. Radiotherapy should therefore not be delayed in patients requiring radiation, despite the presence of COVID-19. In conclusion, radiotherapy for breast cancer patients with COVID 19 is feasible and well tolerated in minimally symptomatic patients treated by techniques adapted to their anatomy. These data need to be confirmed by longer follow-up in this population of patients. The author would like to thank all participants in this study, the group of COVID-19, the institutional staff, and all our patients. No conflict of interest. Data are stored in an institutional data base and are accessible upon request. https://orcid.org/0000-0002-1795-7509 COVID-19) -World Health Organization n Genotype and phenotype of COVID-19: their roles in pathogenesis Practical guidelines for the radiotherapy for patients presented with haematological malignancies in the epidemic COVID-19 situation: International Lymphoma Radiation Oncology Group recommendations COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area Evaluation of the early adverse effects of radiotherapy in breast cancer patients with COVID-19: Prospective single institutional study