[Management of a radiotherapy center during the COVID-19 outbreak: The experience of the Mulhouse hospital centre (France)]. / Organisation d'un service de radiothérapie pendant l'épidémie de COVID-19 : expérience du centre hospitalier de Mulhouse.

The COVID-19 outbreak grows exponentially in our country. Despite most of patients develops benign symptoms, cancer patients are at risk of a severe form of the disease. Radiotherapy centres are a potential contamination place due to the number of patients treated and staff present. Their organization during the outbreak period aims to ensure continuity of care while limiting the risk of death from COVID-19. In the radiotherapy department of Mulhouse hospital (France), we pointed five points out: protection of medical and paramedical staff, protection of patients undergoing treatment, detection of patients suspected of being infected by SARS-CoV-2 and their management, reorganization of the patient circuit and measures regarding the quality management. This reflection, which began at the beginning of the outbreak in our city, allows us to preserve the access to radiotherapy treatments by anticipating the risk of spreading the virus. Through biweekly meetings, we continue to adapt to the epidemic in our department, considering our material resources. The ability to perform diagnostic tests in all suspect patients would also allow us to refine our procedures.

[Evaluation of a predictive score for malnutrition in patients treated by irradiation for head and neck cancer: a retrospective study in 127 patients]. / Évaluation d'un score prédictif de dénutrition chez les patients pris en charge par irradiation pour un cancer des voies aérodigestives supérieures : étude rétrospective chez 127 patients.

PURPOSE: The purpose of this study was to establish a pre-therapeutic score that could predict which patients would be at high risk of enteral tube feeding during (chemo)-radiotherapy for head and neck cancer. PATIENTS AND METHODS: A monocentric study was conducted retrospectively on patients receiving a radiotherapy or concurrent chemoradiotherapy for a head and neck cancer. A logistic model was performed in order to assess clinical or therapeutic risk factors for required artificial nutrition during treatment. Significant parameters, issued from multivariate analysis, were summed and weighted in a score aiming at estimating a malnutrition risk during radiotherapy. RESULTS: Among the 127 evaluated patients, 59 patients required artificial nutrition during radiotherapy. In multivariate analysis, predictive factors for malnutrition were weight loss superior to 5% in the 3 months before radiotherapy, advanced tumor stage (III-IV vs. I-II), and pain requiring strong analgesics (step II-III vs. I). Concurrent chemotherapy was identified as a significant risk factor also, but it was strongly correlated with the tumor stage. The score, estimated from these previous factors, allowed a prediction of a risk of enteral feeding with a sensitivity of 90% and a specificity of 85%. CONCLUSION: A predictive score of enteral nutrition before radiotherapy of head and neck cancer should be a useful clinical tool to target the patients who would need a prophylactic gastrostomy. Our study evidenced some risk factors of malnutrition requiring artificial feeding. However, we need a prospective study to confirm the validity of this score.