Shift in indications for radiotherapy during the COVID-19 pandemic? A review of organ-specific cancer management recommendations from multidisciplinary and surgical expert groups

Dirk Vordermark

doi:10.1186/s13014-020-01579-3

Abstract

To examine, if a shift in indications for radiotherapy is to be expected in the context of the COVID-19 pandemic, the database Pubmed was searched for multidisciplinary or surgical expert recommendations on the role of radiotherapy in modified treatment concepts. Increased use of radiotherapy or chemoradiation instead of surgical treatment was recommended for defined patient groups with head-and-neck cancer, lung cancer, cervix cancer, esophageal cancer and prostate cancer. Omission of radiotherapy was considered in elderly patients with low-risk breast cancer and in early-stage Hodgkin’s lymphoma. Only adjustments to the timing of radiotherapy were discussed for sarcoma and rectal cancer. Emerging recommendations on multidisciplinary cancer treatment concepts during the COVID-19 pandemic indicate a shift in radiotherapy indications and a potentially increased demand for radiotherapy.

Highlights

Responding to the ongoing COVID-19 pandemic, recommendations regarding the use of radiotherapy for cancer treatment and the reduction of risks in the radiotherapy process under the impact of limited resources have been presented from the radiation oncology community, including a recent statement from Germanspeaking university radiation oncology departments [1]
Head and neck cancer A thorough review of treatment concepts for head-andneck cancer in the light of risks posed by the COVID-19 pandemic was presented by an interdisciplinary expert group from the University of Texas Southwestern [10]
Surgical treatment was seen as related to a high number of risks including the combination of aerosol-generating events (e. g. coughing) and aerosolgenerating procedures in the operating room in patients for whom the status of COVID-19 infection may be unclear

Summary

Introduction

Responding to the ongoing COVID-19 pandemic, recommendations regarding the use of radiotherapy for cancer treatment and the reduction of risks in the radiotherapy process under the impact of limited resources have been presented from the radiation oncology community, including a recent statement from Germanspeaking university radiation oncology departments [1].Radiotherapy expert groups have published specific recommendations on radiotherapy use in response to COVID-19 in selected tumor entities including breast cancer, head-and-neck cancer, prostate cancer and lung cancer [2–6], often focusing on the acceptability ofIn addition, multidisciplinary expert groups around the globe have published statements on the use of specific treatment modalities and their combinations during the pandemic, in particular addressing situations of limited availability of cancer surgery and related postoperative intensive care as well as reduced capacity of inpatient supportive care as part of intensive medical cancer therapy.This work focusses on published site-specific cancer treatment recommendations from multidisciplinary and Vordermark Radiation Oncology (2020) 15:140 surgical expert groups and the question if radiotherapy will be required more or less frequently under the conditions of the pandemic. Radiotherapy expert groups have published specific recommendations on radiotherapy use in response to COVID-19 in selected tumor entities including breast cancer, head-and-neck cancer, prostate cancer and lung cancer [2–6], often focusing on the acceptability of. Multidisciplinary expert groups around the globe have published statements on the use of specific treatment modalities and their combinations during the pandemic, in particular addressing situations of limited availability of cancer surgery and related postoperative intensive care as well as reduced capacity of inpatient supportive care as part of intensive medical cancer therapy. This work focusses on published site-specific cancer treatment recommendations from multidisciplinary and Vordermark Radiation Oncology (2020) 15:140 surgical expert groups and the question if radiotherapy will be required more or less frequently under the conditions of the pandemic

Methods

Results

Conclusion