key: cord-1017550-q1sf6f39
authors: Gorospe, Luis; Ayala-Carbonero, Ana María; Paredes-Rodríguez, Patricia; Muñoz-Molina, Gemma María; Arrieta, Paola; Mirambeaux-Villalona, Rosa Mariela; Vallejo-Ocaña, María Carmen; Benito-Berlinches, Amparo; Lage-Alfranca, Yolanda; Gómez-Rueda, Ana
title: Challenges in lung cancer patient management in times of COVID-19: an imaging perspective
date: 2020-08-25
journal: Clin Lung Cancer
DOI: 10.1016/j.cllc.2020.08.001
sha: f76fec7ecb8c37663d6ed667d42c91b4b3edbb16
doc_id: 1017550
cord_uid: q1sf6f39

nan

To the Editor:

We fully agree with Dr. Guerini et al regarding how challenging can be the differentiation between lung toxicity and SARS-CoV-2 infection in lung cancer (LC) patients. 1 However, we would like to comment on the management complexity of LC patients (both for new tumor diagnoses and for known cancer patients) during the COVID-19 pandemic beyond lung toxicity. There are few publications that address the clinical management of patients with LC in the current SARS-CoV-2 pandemic. 2-5 The clinical and radiological manifestations of COVID-19 can mimic pulmonary toxicity or progression of tumor disease in LC patients. 6 Some extrapulmonary complications of SARS-CoV-2 pneumonia may also simulate progression of cancer disease. 7 On the other hand, some treatment-related complications of LC patients can radiologically mimic SARS-CoV-2 pneumonia. 8, 9 Finally, the management of some diagnostic interventional procedures can be difficult in COVID-19 patients with LC. 10 In this letter we describe our experience in the management of several LC patients during the COVID-19 pandemic that affected our region, and which required close multidisciplinary collaboration between different specialists. COVID-19. On a CT staging study, a thickening of the pericardium and the appearance of bilateral pleural effusions were observed (not present 3 weeks before when the diagnosis of COVID-19 and lung mass was made) (Fig. 1E) . The patient stated that, after improving the COVID-19 symptoms, he presented an episode of low-grade fever and chest pain that changed with posture variation. An empirical retrospective diagnosis of acute post-COVID-19 pleuropericarditis was made, and the symptoms improved after the administration of colchicine. A follow-up chest CT demonstrated resolution of the pericardial thickening and the pleural effusions.

This is a 50-year-old male with a simultaneous diagnosis of a lung mass and COVID-19 ( Fig. 1F ). In spite of the active SARS-CoV-2 infection, it was decided to perform a CTguided core needle biopsy of the lung mass (the staff involved followed the infection control protocol of our hospital and used personal protective equipment during the biopsy procedure).

mimicking COVID-19. On a follow-up study, an asymptomatic 47-year-old woman with locally advanced LC that was being treated with immunotherapy (durvalumab) showed the appearance of pulmonary ground-glass attenuation opacities and hypermetabolic bilateral mediastinal and hilar lymphadenopathies (Fig. 1G, 1H) . 

Differential Diagnosis and Clinical Management of a Case of COVID-19 in a Patient With Stage III Lung Cancer Treated With Radio-chemotherapy and Durvalumab

Small Cell Lung Cancer During the COVID-19 Global Pandemic

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel

Recommendations of individualized medical treatment and common adverse events management for lung cancer patients during the outbreak of COVID-19 epidemic

Challenges in lung cancer therapy during the COVID-19 pandemic

COVID-19 or Lung Cancer: A differential diagnostic experience and management model from Wuhan

COVID-19: the use of immunotherapy in metastatic lung cancer

Need for Caution in the Diagnosis of Radiation Pneumonitis in the COVID-19 Pandemic

FIGURE LEGEND Figure 1. A, CT image shows a solid lung tumor nodule (black arrow) and several peripheral sub-segmental ground-glass attenuation opacities of infectious nature

In this case the radiological findings contributed to the correct management of the patient. D, CT image shows extensive ground-glass opacities. The absence of infectious symptoms suggested a pulmonary toxicity. E, CT image (staging study) shows a new pericardial thickening (arrows) and a bilateral pleural effusion (asterisk), and an empirical diagnosis of post-COVID acute pericarditis was made. F, CT image shows an incidentally detected mass in the right hemithorax (asterisk); note the presence of bilateral pulmonary consolidations. A percutaneous CT-guided biopsy was performed. G, PET/CT image shows the appearance of hypermetabolic lymph nodes in the mediastinum and both pulmonary hila (arrows), suggesting the diagnosis of sarcoid reaction. H, CT image (same patient as G) shows the appearance of multiple small

Conflict of interest statement: The authors declare no conflict of interest