New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era
Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infectio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/4/587 |
| _version_ | 1797414939807186944 |
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| author | Camil Ciprian Mireștean Anda Crișan Adina Mitrea Călin Buzea Roxana Irina Iancu Dragoș Petru Teodor Iancu |
| author_facet | Camil Ciprian Mireștean Anda Crișan Adina Mitrea Călin Buzea Roxana Irina Iancu Dragoș Petru Teodor Iancu |
| author_sort | Camil Ciprian Mireștean |
| collection | DOAJ |
| description | Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario. |
| first_indexed | 2024-03-09T05:41:15Z |
| format | Article |
| id | doaj.art-8041b67bd0064c51884312f72b92b8af |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T05:41:15Z |
| publishDate | 2021-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8041b67bd0064c51884312f72b92b8af2023-12-03T12:24:36ZengMDPI AGJournal of Clinical Medicine2077-03832021-02-0110458710.3390/jcm10040587New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic EraCamil Ciprian Mireștean0Anda Crișan1Adina Mitrea2Călin Buzea3Roxana Irina Iancu4Dragoș Petru Teodor Iancu5Department of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, RomaniaDepartment of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, RomaniaCounty Clinical Emergency Hospital Craiova, 200642 Craiova, RomaniaNational Institute of Research and Development for Technical Physics, 700050 Iaşi, RomaniaDepartment of Oral Pathology, Gr. T. Popa, University of Medicine and Pharmacy, 700115 Iaşi, RomaniaDepartment of Oncology and Radiotherapy, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, RomaniaLocally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario.https://www.mdpi.com/2077-0383/10/4/587head and neck cancernon-surgicalradiotherapychemotherapyCovid-19 |
| spellingShingle | Camil Ciprian Mireștean Anda Crișan Adina Mitrea Călin Buzea Roxana Irina Iancu Dragoș Petru Teodor Iancu New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era Journal of Clinical Medicine head and neck cancer non-surgical radiotherapy chemotherapy Covid-19 |
| title | New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era |
| title_full | New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era |
| title_fullStr | New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era |
| title_full_unstemmed | New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era |
| title_short | New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era |
| title_sort | new challenges of treatment for locally advanced head and neck cancers in the covid 19 pandemic era |
| topic | head and neck cancer non-surgical radiotherapy chemotherapy Covid-19 |
| url | https://www.mdpi.com/2077-0383/10/4/587 |
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