WHO reported in July 2021 that more than 3 billion vaccines had been administrated [2]. The safety of COVID-19 vaccination during radiotherapy is not clear. We experienced a patient who received a COVID-19 vaccine during radiotherapy. She suffered from severe vertigo and radiotherapy had to be suspended for 4 days. Fortunately, there is no clear evidence that the effectiveness of radiotherapy after partial mastectomy is reduced by suspension of radiotherapy for a few days. However, it had been reported that results in a worse treatment outcome in other cancer sites [3, 4]. Therefore, if patients receive a COVID-19 vaccine during radiotherapy, physicians need to consider the association between prolongation of radiotherapy duration and treatment outcomes.

Patients with cancer had more severe events of COVID-19 than did patients without cancer and that lung cancer was the most frequent cancer site [5]. Cancer patients with COVID-19 had a higher death rate, higher rate of admission to an intensive care unit, higher frequency of severe symptoms, and higher frequency of machine ventilation than those in non-cancer patients with COVID-19 [6]. Zhang et al. reported that 3 patients (10.7%) received chemotherapy, 1 patient (3.6%) received radiotherapy, 2 patients (7.1%) received molecular targeted therapy and 1 patient (3.6%) received immunotherapy within 14 days of the onset of COVID-19 among 28 COVID-19 patients with cancer [7]. Radiotherapy had less effect than drug therapy on COVID-19. Thus, patients with cancer have many disadvantages compared to patients without cancer.

Our patient received a Tozinameran vaccine (Pfizer Inc, Germany). Tozinameran is an mRNA vaccine and its effectiveness after 2 doses had been reported to be 95.3% [8]. Vaccine-related adverse events occurred in 21% of the participants who received Tozinameran and in 5% of the participants who received a placebo, and 2 participants who received Tozinameran and 4 participants who received a placebo died [9]. The participants in that study included participants with a shoulder injury, axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and leg paresthesia, and participants under 55 years of age had more local and systemic adverse events than did participants aged 55 years or over. The people younger than 65 years of age had more local and systematic reactions than did people 65 years of age or older who received a Tozinameran or Moderna COVID-19 vaccine [10]. Our patient was 60 years old and it is therefore possible that she had greater adverse effects of the vaccine. She suffered from hypertension and severe vertigo. Hypertension and severe vertigo occurred after the second vaccination, and we speculate that these adverse events were associated with the vaccine. However, it is unclear whether radiotherapy made these adverse events more severe.

Partial mastectomy followed by radiotherapy is one of the common treatment strategies for breast cancer. Patients have to make many visits to a hospital for radiotherapy. Therefore, the COVID-19 Pandemic Breast Cancer Consortium has recommended a hypofractionated regimen in order to reduce the number of visits to a hospital [11]. Gasparri et al. reported that 48% of centers in 44 countries changed the radiotherapy procedure [12]. In their study, 22.6% of the centers postpone radiotherapy for patients with low risk, 23.3% of the centers treated patients with hypofractionated radiotherapy, and 2.1% of the centers changed the radiotherapy from a hospital-based procedure to an office-based procedure. Radiotherapy had to be suspended for patients with poor health conditions such as COVID-19 and adverse vaccine-related events during radiotherapy. Consideration should be given to hypofractionated radiotherapy in order to reduce such risks.

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