Older cancer patients during the COVID-19 epidemic: Practice proposal of the international geriatric radiotherapy group

The coronavirus disease 19 (COVID-19) pandemic is unprecedented as it reached all countries in the world within a record short period of time. Even though COVID-19 infection may be just severe in any adults, older adults (65-year-old or older) may experience a higher mortality rate. Among those affected, cancer patients may have a worse outcome compared to the general population because of their depressed immune status. As the health resources of most countries are limited, clinicians may face painful decisions about which patients to save if they require artificial ventilation. Cancer patients, especially the older ones, may be denied supportive care because of their shorter life expectancy. Thus, special considerations should be taken to prevent infection of older cancer patients and to provide them with adequate social support during their cancer treatment. The following proposal was reached: (1) Education of health care providers about the special needs of older cancer patients and their risks of infection. (2) Special consideration such as surgical masks and separate scheduling should be made to protect them from being infected. (3) Social services such as patient navigators should be provided to ensure adequate medical supply, food, and daily transportation to cancer centers. (4) Close monitoring through phone calls, telecommunication to ensure social distancing and psychological support from patient family to prevent anxiety and depression. (5) Shorter course of radiotherapy by use of hypofractionation where possible to decrease the needs for daily transportation and exposure to infection. (6) Enrollment of older cancer patients in clinical trials for potential antiviral medications if infection does occur. (7) Home health care telemedicine may be an effective strategy for older cancer patients with COVID-19 infection to avoid hospital admission when health care resources become restricted. (8) For selected patients, immunotherapy and targeted therapy may become the systemic therapy of choice for older cancer patients and need to be tested in clinical trials

Whole-lung low dose irradiation for SARS-Cov2 induced pneumonia in the geriatric population: An old effective treatment for a new disease? Recommendation of the international geriatric radiotherapy group

A cytokine storm induced by SARS-Cov2 may produce pneumonitis which may be fatal for older patients with underlying lung disease. Hyper-elevation of Interleukin1 (IL-1), Tumor necrosis factor-1alfa (TNF-1 alfa),and Interleukin 6 (IL-6) produced by inflammatory macrophage M1 may damage the lung alveoli leading to severe pneumonitis, decreased oxygenation, and potential death despite artificial ventilation. Older patients may not be suitable candidates for pharmaceutical intervention targeting IL-1/6 blockade or artificial ventilation. Low dose total lung (LDTL) irradiationat a single dose of 50 cGy may stop this cytokine cascade,thus preventing, and/or reversing normal organs damage. This therapy has been proven in the past to be effective against pneumonitis of diverse etiology and could be used to prevent death of older infected patients. Thus, LDRT radiotherapy may be a cost-effective treatment for this frail patient population whom radiation -induced malignancy is not a concern because of their advanced age.This hypothesis should be tested in future prospective trials

Can radiotherapy finally “go live” in the management of liver metastases?

Liver metastases can present synchronously or at different time points. While systemic therapy continues to be the mainstay of treatment for patients with liver metastases, it is unlikely to completely eradicate the disease. Surgical “metastectomy” for patients with limited metastatic burden, particularly from colorectal cancers, has been shown to improve survival. However, owing to medical co-morbidities or tumour location, not all patients are eligible for surgical resection. In recent years, there has been an increase in the use of non-surgical techniques, including high dose radiation using stereotactic body radiotherapy, or brachytherapy, to ablate liver metastases. The purpose of this narrative review is to describe the role of radiotherapy in the management of liver metastases, both for local ablation and symptom palliation. We will elaborate on the techniques used, patient selection process, expected outcomes and toxicities based on the current literature