During a global pandemic the benefit of routine visits and treatment of cancer patients must be weighed against the risks to patients, staff, and society. Prostate cancer is one of the most common cancers Radiation Oncology departments treat, and efficient resource utilization is essential in the setting of a pandemic. Herein, we aim to establish recommendations and a framework by which to evaluate prostate radiotherapy management decisions.
Radiation Oncologists from the United States and United Kingdom rapidly conducted a systematic review and agreed upon recommendations to safely manage prostate cancer patients during the COVID-19 pandemic. A RADS framework was created: Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy was applied to determine appropriate approaches.
Recommendations are provided by National Comprehensive Cancer Network (NCCN) risk group, including clinical node positive, post-prostatectomy, oligometastatic, and low volume M1 disease. Across all prostate cancer stages, telemedicine consultations and return visits were recommended when resources/staff available. Delays in consultations and return visits was deemed safe based on stage of disease between 1-6 months. Treatment can be avoided or delayed until safe for very low, low, and favorable intermediate-risk disease. Unfavorable intermediate-risk, high-risk, clinical node positive, recurrence post-surgery, oligometastatic, and low-volume M1 disease can receive neoadjuvant hormone therapy for 4-6 months as necessary. Ultrahypofractionation was preferred for localized, oligometastatic, and low volume M1, and moderate hypofractionation was preferred for post-prostatectomy and clinical node positive disease. Salvage was preferred to adjuvant radiation.
Resources can be reduced for all identified stages of prostate cancer. The RADS (Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy) framework can be applied to other disease sites to help with decision making in a global pandemic.
Advances in radiation oncology. 2020 Apr 01 [Epub ahead of print]
Nicholas G Zaorsky, James B Yu, Sean M McBride, Robert T Dess, William C Jackson, Brandon A Mahal, Ronald Chen, Ananya Choudhury, Ann Henry, Isabel Syndikus, Timur Mitin, Alison Tree, Amar U Kishan, Daniel E Spratt
Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA., Department of Therapeutic Radiology/Radiation Oncology, Yale, New Haven, CT, USA., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA., Department of Radiation Oncology, Dana Farber, Boston, MA, USA., Department of Radiation Oncology, University of Kansas, Kansas City, KS, USA., Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK., Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust and the University of Leeds, Leeds, UK., Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK., Knight Cancer Institute, Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA., Radiotherapy and Imaging Division, Institute of Cancer Research, Sutton, London, UK., Department of Radiation Oncology, UCLA, Los Angeles, CA, USA.