Dados do Trabalho

Título

Sars-Cov2/COVID-19 impact on breast cancer radiotherapy practice: A single institution analysis.

Introdução

Sars-Cov2/COVID-19 pandemic is an international healthy emergency issue. Several Radiotherapy centers developed hypofractionation (HF) protocols to reduce patients visits. In breast cancer (BC), moderate HF (MHF) schemes that were recommended for whole breast irradiation (WBI) after breast conserving surgery before the pandemic, started to be applied in patients undergoing mastectomy or to treat the regional lymphatics (RL). Strategies like the incorporation of simultaneous integrated boost (SIB) to the MHF protocol or the use of Ultra HF (UHF) scheme, gained particular significance and relevance in the last year.

Objetivo

To compare the BC patients’ characteristics and BC treatment (BCT) indications before and during COVID-19 pandemic.

Método

We retrospectively evaluated the records of patients treated in the year of 2018 and 2020 at HSP/UNIFESP for clinical, pathological and treatment characteristics. Patients included had age ≥ 18 years and were treated with adjuvant radiotherapy. Comparisons were done using Pearson's chi-square test and Fisher's exact test.

Resultados

115 women were evaluated, 61 were treated in 2018 and 54 in 2020. The median age of both groups was 56 years. In absolute values, first time visits of breast cancer dropped 11,5%. Indication of conventional fractionation (CF) for WBI dropped from 55% in 2018 to 15% in 2020, while HF indication raised from 45% to 85%. Use of CF on RL also dropped from 95% in 2018 to 57% in 2020, while HF raised from 5% to 43%. Boost indication had a trend to be significantly less indicated during pandemic (p=0,095). Sequential boost indications dropped from 100% in 2018 to 42% in 2020, while SIB indication raised from 0 to 58%. The type of fractionation used (p<0.001), the type of boost used (p<0.001) and the fractionation used to treat RL (p=0.007) were the indications that were significantly modified after statistical analysis.

Conclusão

COVID-19 pandemic accelerated the use of MHF in BCT, especially in patients with advanced stage and with RL irradiation. We also observed an increased use of UHF in initial stage BC. Although we did not observe a significant change in clinical and pathological characteristics in patients at our institution, there is a major concern on the impact of the covid-19 pandemic on cancer care specially in our country where radiotherapy access is limited.

Palavras-chave

Breast Cancer, Radiotherapy, COVID-19