Two months of radiation oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice
Authors: Buglione Michela , Spiazzi Luigi , Guerini Andrea Emanuele , Barbera Fernando , Pasinetti Nadia , Pegurri Ludovica , Triggiani Luca , Tomasini Davide , Greco Diana , Costantino Gianluca , Bragaglio Alessandra , Bonometti Nadia , Liccioli Mara , Mascaro Lorella ,   Radiation Oncology Department Staff, Adami Manuela , Alghisi Alessandro , Barucco Sara , Bazzana Davide , Bedussi Elena , Biondi Maria Luisa , Bonù Marco Lorenzo , Borghetti Paolo , Bresciani Cristina , Brontesi Tazio , Caraffini Bruno , Cavallini Adriano , Cisca Patrizia , Ciulli Daniela , Consoli Mariella , Contrini Lara , Contessa Marica , Corrado Flaviano , Costa Loredana , Cristiano Antonietta , Croitoriu Ana , De Agostini Antonio , De Vita Ivana , Di Gangi Francesca , Di Paolo Amelia , Di Virgilio Giuseppina , Donofrio Alessandra , D’Oronzo Michele , Errico Michela , Facca Maria Grazia , Facheris Giorgio , Ferrari Adele , Fiorenza Rosalia , Fiume Alfredo , Floriani Stefania , Franzoni Antonella , Franco Giada , Frassine Francesco , Frassine Sara , Gandinelli Giulia , Gandini Francesca , Garau Stefania , Ghidini Manuela , Ghedi Barbara , Giammarresi Gabriella , Giorgi Amelia , Gitti Roberta , Guaineri Annamaria , Iannello Giuseppe , Imbrescia Jessica , Inturri Angela , Inselvini Cinzia , Leali Sabrina , La Mattina Salvatore , Maddalo Marta , Marini Emanuela , Maruca Laura , Mensi Paola , Pastorello Edoardo , Pedretti Sara , Peretto Gloria , Piazza Biagio , Polonini Alessia , Prandelli Giampietro , Premi Anna , Provezza Claudio , Ragazzoli Vanessa , Ranghetti Elena , Rinaldi Alessandra , Rodella Carlo Alberto , Romano Luca , Rubini Elisabetta , Saiani Federica , Salah Emiliano , Santoro Valeria , Scala Rossella , Scalvi Monica , Sessini Mara , Singh Navdeep , Taddeo Alessandra , Terraneo Fabrizia , Toraci Cristian , Turla Ottavia , Vitali Paola , Volpi Giulia , Zampedri Laura , Alongi Filippo , Magrini Stefano Maria , Alongi Filippo , Magrini Stefano Maria 
Published: August 2020

Abstract
Background
Coronavirus Disease 2019 (COVID-19) pandemic had an overwhelming impact on healthcare worldwide. Outstandingly, the aftermath on neoplastic patients is still largely unknown, and only isolated cases of COVID-19 during radiotherapy have been published. We will report the two-months experience of our Department, set in Lombardy “red-zone”.

Methods
Data of 402 cancer patients undergoing active treatment from February 24 to April 24, 2020 were retrospectively reviewed; several indicators of the Department functioning were also analyzed.

Results
Dedicated measures allowed an overall limited reduction of the workload. Decrease of radiotherapy treatment number reached 17%, while the number of administration of systemic treatment and follow up evaluations kept constant. Conversely, new treatment planning faced substantial decline. Considering the patients, infection rate was 3.23% (13/402) and mortality 1.24% (5/402). Median age of COVID-19 patients was 69.7 years, the large majority were male and smokers (84.6%); lung cancer was the most common tumor type (61.5%), 84.6% of subjects were stage III-IV and 92.3% had comorbidities. Remarkably, 92.3% of the cases were detected before March 24. Globally, only 2.5% of ongoing treatments were suspended due to suspect or confirmed COVID-19 and 46.2% of positive patients carried on radiotherapy without interruption. Considering only the last month, infection rate among patients undergoing treatment precipitated to 0.43% (1/232) and no new contagions were reported within our staff.

Conclusions
Although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during SARS-Cov-2 pandemic by endorsing consistent preventive measures.