TY - JOUR
T1 - Radiation Fractionation Schedules Published During the COVID-19 Pandemic
T2 - A Systematic Review of the Quality of Evidence and Recommendations for Future Development
AU - Thomson, David J.
AU - Yom, Sue S.
AU - Saeed, Hina
AU - El Naqa, Issam
AU - Ballas, Leslie
AU - Bentzen, Soren M.
AU - Chao, Samuel T.
AU - Choudhury, Ananya
AU - Coles, Charlotte E.
AU - Dover, Laura
AU - Guadagnolo, B. Ashleigh
AU - Guckenberger, Matthias
AU - Hoskin, Peter
AU - Jabbour, Salma K.
AU - Katz, Matthew S.
AU - Mukherjee, Somnath
AU - Rembielak, Agata
AU - Sebag-Montefiore, David
AU - Sher, David J.
AU - Terezakis, Stephanie A.
AU - Thomas, Toms V.
AU - Vogel, Jennifer
AU - Estes, Christopher
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - PURPOSE: Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study.METHODS AND MATERIALS: Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios.RESULTS: From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications.CONCLUSIONS: A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.
AB - PURPOSE: Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study.METHODS AND MATERIALS: Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios.RESULTS: From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications.CONCLUSIONS: A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.
KW - COVID-19
KW - Coronavirus Infections/epidemiology
KW - Dose Fractionation, Radiation
KW - Evidence-Based Medicine/methods
KW - Humans
KW - Pandemics
KW - Pneumonia, Viral/epidemiology
KW - Publications
UR - http://www.scopus.com/inward/record.url?scp=85089826934&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089826934&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2020.06.054
DO - 10.1016/j.ijrobp.2020.06.054
M3 - Article
C2 - 32798063
AN - SCOPUS:85089826934
SN - 0360-3016
VL - 108
SP - 379
EP - 389
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -
