Systematic screening of COVID-19 disease based on chest CT and RT-PCR for cancer patients undergoing radiotherapy in a coronavirus French hotspot
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
Background : Cancer patients are presumed to be more vulnerable to COVID-19. We evaluated a screening strategy combining chest computed-tomography (CT) and reverse transcription polymerase chain reaction (RT-PCR) for patients treated with radiotherapy (RT) in our cancer center located in a COVID-19 French hotspot during the first wave of the pandemic.
Methods : Chest CT images were proposed during the radiotherapy CT simulation. Images were reviewed by an expert radiologist according to the CO-RADS classification. Nasal swabs with RT PCR assay were initially proposed in case of suspicious imaging or clinical context and were eventually integrated into the systematic screening. A dedicated radiotherapy workflow was proposed for COVID-19 patients to limit the risk of contamination.
Results : From March 18, 2020 to May 1, 2020, 480 patients were screened by chest CT, with 313 patients having both chest CT and RT-PCR (65%). Cumulative incidence of COVID-19 was 5.4%, 95%CI [3.6, 7.8] (26 patients out of 480). Diagnosis of COVID-19 was made before RT for 22 patients (84.6%) and during RT for 4 patients (15.3%). Chest CT directly aided the diagnosis of 7 cases for whom the initial RT-PCR was negative or not feasible; out of a total of 480 patients (1.5%) and 517 chest CT acquisition. Four patients with COVID-19 at the time of the chest CT screening had a false negative CT. Sensitivity and specificity of chest CT screening in patients with both RT-PCR and chest CT testing were estimated to be 0.82, 95% CI [0.60, 0.95] and 0.98, 95% CI [0.96, 0.99] respectively.Adaptation of the radiotherapy treatment was made for all the patients with seven postponed treatments (median=5 days, IQR [1.5, 14.8]).
Conclusion : The benefit of systematic use of chest CT screening during CT simulation for patients undergoing radiotherapy during the COVID-19 pandemic seemed limited.
International Journal of Radiation Oncology, Biology, Physics , résumé, 2020