Assessment of Side Effects of Radiation Therapy in Patients With COVID-19 Treated for Early-Stage Breast Cancer

Allali, S.; Beddok, A.; Servois, V.; Fourquet, A.; Kirova, Y.

Purpose/Objective(s) 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 and late toxicity in patients infected with COVID-19 treated at the same time for early-stage breast cancer (BC) toxicity. Materials/Methods This is a monocentric prospective study of patients treated in our hospital between March and June 2020. The monocentric registry was created for all cancer patients who were diagnosed with COVID 19 infection. The inclusion criteria of the patients evaluated were to be irradiated for early-stage breast cancer and to have a positive COVID diagnosis on a PCR test and / or a lung computed tomography (CT) scan and / or suggestive clinical symptoms. All of them needed 6 months follow up clinic after the end of the radiotherapy with clinical examination, mammogram, as well as CT scan to evaluate the lung status. Radiotherapy (RT) consisted of 50 Gy to the breast or chest wall with or without lymph node irradiation, as well as hypofractionated schemes adapted to pandemic situation. The treatment-related toxicity was graded according to the CTCAE (version 4.03). Results Three hundred fifty patients (pts) have been treated for early-stage BC in our Department between 03/2017 and 06/2020. 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. All patients were invited to realize CT scan 6 months after the end of RT and to come in the hospital for clinical and radiological evaluation. During the radiotherapy, there were 9 pts presented radio dermatitis, of the 8 (66%): grade 1 and one (8%) grade 2. Two patients treated to the regional lymph nodes presented esophagitis de grade 2. The late toxicity as well as the lung radiological evaluation was realized 6 months after the end of the radiotherapy and there was no RT or COVID lung sequel on the CT scans. There was one patient who presented COVID related dyspnea, and 2 patients with post treatment fibrosis. Conclusion The half-year follow-up of prospective COVID19+ cohort, treated for early-stage BC demonstrated an acceptable toxicity profile with few low-grade adverse events. It seems that the COVID 19 infection does not appear to increase the side effects of RT. Therefore, the RT should not be delayed.