Disease Site-Specific Guidelines for Curative Radiation Treatment During 'Limited Surgery' and 'Hospital Avoidance': A Radiation Oncology Perspective From the Epicenter of COVID-19 Pandemic.

Bhupesh Parashar,Louis Potters,William C Chen,Joseph M Herman

doi:10.7759/cureus.8190

Abstract

The COVID-19 pandemic has resulted in an unprecedented situation where the standard of care (SOC) management for cancers has been altered significantly. Patients with potentially curable cancers are at risk of not receiving timely SOC multidisciplinary treatments, such as surgery, chemotherapy, radiation therapy, or combination treatments. Hospital resources are in such high demand for COVID-19 patients that procedures, such as surgery, dentistry, interventional radiology, and other ancillary services, are not available for cancer patients. Our tertiary care center is considered the center of the epicenter in the USA. As a result, all non-emergent surgeries have been suspended in order to provide hospital beds and other resources for COVID-19 patients.Additionally, ambulatory efforts to avoid treatment-related morbidity are critical for keeping patients out of emergency departments and hospitals. In this review article, we discuss evidence-based radiation therapy approaches for curable cancer patients during the COVID-19 pandemic. We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ‘bridge’ to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy.

Highlights

BackgroundThe main challenge faced during the coronavirus disease 2019 (COVID-19) pandemic is the need to maintain access to proper cancer treatment
We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ‘bridge’ to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy
The pandemic has resulted in an unforeseen and unprecedented situation where major hospitals and academic centers are overwhelmed with COVID-19 patients, with limited access to standard of care (SOC) cancer treatments

Summary

Introduction

The main challenge faced during the coronavirus disease 2019 (COVID-19) pandemic is the need to maintain access to proper cancer treatment. Most operations are being postponed in order to provide hospital capacity for COVID-19 patients and to reduce the risk of COVID-19 infection in patients that undergo surgery for non-emergent clinical situations. Amid this social and medical upheaval, there is concern and confusion regarding the best way to manage the treatment of potentially curable cancer patients. In order to minimize the risk of exposure to COVID-19 and maintain high-quality patient care with optimal disease outcomes, we have used the following principles to guide our institutional approach to cancer care: How to cite this article Parashar B, Chen W C, Herman J M, et al (May 18, 2020) Disease Site-Specific Guidelines for Curative Radiation Treatment During ‘Limited Surgery’ and ‘Hospital Avoidance’: A Radiation Oncology Perspective From the Epicenter of COVID-19 Pandemic. Multidisciplinary discussion for each patient case (virtual or in-person with social distancing)

Short-course hypofractionated RT is preferred when feasible

Conclusions

Disclosures