Radiotherapy for Lung Cancer During the COVID Pandemic – A Narrative Review of Practical Recommendations

Author(s) :

Prasenjit Chatterjee1, Jibak Bhattacharya1, Tanmay Ghosh1, Biplab Sarkar Dip1, Monica-Emilia Chirila2, Sushmita Roy Chowdhury3, Syamasis Bandyopadhyay4, Jayaprakash Agarwal5

1 Department of Radiotherapy , Apollo Hospitals, Kolkata, India

2 Amethyst Radiotherapy Centre, Cluj-Napoca, Romania

3 Department of Pulmonary Medicine, Apollo Hospitals, Kolkata, India

4 Department of Rheumatology, Apollo Hospitals, Kolkata, India

5 Department of Radiotherapy, Tata Memorial Hospitals, Mumbai, India

Corresponding author: Prasenjit Chatterjee, Email:

Published: Journal of Medical and Radiation Oncology 1 (2021) 99-116, , , - DOI: 10.53011/JMRO.2021.01.10

Open Access

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March 22, 2021 0 Comments


Background: The coronavirus disease pandemic produced changes in the treatment approach of lung cancer patients. They represent a vulnerable population due to the negative impact of delays in diagnosis and treatment and also because of the impaired immune system. Radiation Therapy plays a crucial role in both curative and palliative settings, so finding the best approach for these patients in this context was attempted by many professionals.  The aim of this study was to make a synthesis of the current published literature on this topic and summarize the recommendations.

Material and methods: We searched the PubMed database for articles published between 20th December 2019 and 30th August 2020. We used 14 keywords related to COVID 19 and Lung Cancer. The articles were selected by two senior clinicians who excluded overlapping information and prioritized original research reports and the professional organization’s official recommendations.

Results: There were 562 papers corresponding to the search criteria, of which 64 were analyzed. Treatment decisions must be tailored according to the status of SARS CoV-2 positivity, the aim of the treatment (curative VS palliative), pathological type and clinical stage, disease complications, symptoms, prognostic, performance status, and alternative treatments. Hypofractionation is preferred whenever possible, in order to minimize risk for patients and staff. Safety measures have to be implemented, with extra caution if SARS CoV-2 positive patients have to be treated. Cone beam CT can be used for early identification of lung infiltrates and special attention should be paid to differentiate Radiation pneumonitis from COVID-19 pneumonia.

Conclusion: For SARS CoV-2 positive lung cancer patients the treatment should be postponed until they are tested negative. For patients which are SARS CoV-2 negative treated with curative intent, hypofractionated schedules are preferred. Palliative treatments should be given according to the life-threatening risk.

  Stage/ Location/Specific situation Recommendations



Peripheral lesions in the “safe” zone 34 Gy/ single #
Lesions adjacent to the chest wall 48 Gy/4#; 54 Gy/3#
Moderately Central Tumours 50 Gy/5#
Central/Ultra-central tumors 50-60 Gy/15#
Stage III 55 Gy/20# & sequential chemotherapy



Early stage SBRT
Limited Stage with good performance status ·       40 Gy/15 daily # or 50-55 Gy/20 daily #

·       Brain MRI monitoring instead of PCI

Extensive Stage ·       Omit consolidation CT-RT if complete response of lung disease to chemotherapy

·       Brain MRI monitoring instead of PCI





Priority of cases locally advanced NSCLC > limited-stage SCLC > early-stage NSCLC
If the patient gets infected before start of RT Postpone RT initiation until the patient is asymptomatic and the test for COVID-19 becomes negative.
If the patient gets infected during a course of RT Interrupt RT till recovery from COVID if low risk of tumor progression.
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