Brachytherapy in cervical cancer radiotherapy during COVID-19 pandemic crisis: problems and prospects

Miriyala, Raviteja; Mahantshetty, Umesh

doi:10.5114/jcb.2020.96873

Cited by 11 publications

(16 citation statements)

References 16 publications

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“… Adding approx. 5 Gy per week for each week of BT delay beyond seven weeks, respecting (OARs) tolerance doses ( Barthwal et al, 2020 ) - Reducing the number of applications by delivering multiple fractions with each application - Using higher dose/fr (fewer fraction number) considering the indications (e.g., 3 × 8 Gy or 4 × 7 Gy) ( Miriyala and Mahantshetty, 2020 ; ElMajjaoui et al, 2020 ; Kumar and Dey, 2020 ; Ismaili and Elmajjaoui, 2020 ) Adjuvant treatment: 9 Gy / 2 frs over 2 weeks, over conventional 7 Gy / 3–4 frs or 6 Gy / 5 frs ( Upadhyay and Shankar, 2020 ) 9 Gy × 2 frs weekly (in patients with low volume disease post-RT and in whom inferior local control) ( Kumar and Dey, 2020 ) Stages IB3, IIA2-IIIC2, and early IVA: Intracavitary HDR brachytherapy 3 frs Stages IA1, IA2, IB1, IB2, IIA1: Vault brachytherapy 12 Gy/2 frs ( Hinduja et al, 2020 ) For centers with single brachytherapy operating: postpone at least 24 days or until the infection is resolved Reduced number of fractions: 24 Gy/3 frs or 28 Gy/4 frs HDR ICBT: 7 Gy/4 frs at 1 week apart or 2 frs per day separated by a 6 h interval For patients >70 yrs, significant comorbidities, small tumors, or responding well to RT: -Shortened schedule (9 Gy /2 frs at 1 week apart) -Brachytherapy for cervical cancer (stage IB1, IIIB) ( ElMajjaoui et al, 2020 ) Advanced cervical cancer: temporarily defer interstitial brachytherapy ( Kwek et al, 2021 ) Uterine - Postpone BT but no more than 12 weeks after surgery ( Williams et al, 2020 ) Endometrial - Standard treatment (preferably three frs) ( Aghili et al, 0 ) Inoperable deﬁnitive positive COVID-19 symptomatic patients: - Hold on RT for 10-14 days - Start BT after recovery ( …”

Section: Resultsmentioning

confidence: 99%

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Siavashpour

Goharpey²,

Mobasheri

2021

Critical Reviews in Oncology/Hematology

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Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.

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Section: Resultsmentioning

confidence: 99%

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Siavashpour

Goharpey²,

Mobasheri

2021

Critical Reviews in Oncology/Hematology

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“… 14 - 17 While providing care, measures could be undertaken in individual departments to ensure compliance to nonsurgical (chemoradiotherapy or radiotherapy or brachytherapy) treatment for cervical cancer. 46 …”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Outcomes for Patients With Cervical Cancer in India

Gupta

Chauhan

Prinja

et al. 2021

JCO Global Oncology

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PURPOSE The COVID-19 pandemic has placed unprecedented demands on the health system. This led to delays in the initiation and completion of cancer treatment. We assessed the long-term health consequences because of the delay in diagnosis and treatment for cervical cancer due to COVID-19 in India. METHODS We used a Markov-model–based analysis assessing the lifetime health outcomes of the cohort of women population at risk from cervical cancer in India. The decrease in survival for those with the treatment interruption was calculated based on the number of days the treatment was extended beyond the standard duration. Furthermore, to model the impact of late diagnosis and delayed treatment initiation, the patients were assumed to have upstaged during the delay period, as per natural progression of disease. RESULTS We estimate 2.52% (n = 795) to 3.80% (n = 2,160) lifetime increase in the deaths caused by cervical cancer with treatment restrictions ranging from 9 weeks to 6 months, respectively, as compared to no delay. On the contrary, 88-238 deaths because of COVID-19 disease are estimated to be saved during this restriction period among the patients with cervical cancer. Overall, the excess mortality because of cervical cancer led to 18,159-53,626 life-years being lost and an increase of 16,808-50,035 disability-adjusted life-years. CONCLUSION Delays in diagnosis and treatment are likely to lead to more cervical cancer deaths as compared to COVID-19 mortality averted among the patients with cervical cancer. Health systems must reorganize in terms of priority setting for provision of care, starting with prioritizing the treatment of patients with early-stage cervical cancer, increasing use of teleconsultation, and strengthening the role of primary care physicians in provision of cancer care.

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“…The intent was to reduce anesthesia staff/equipment involvement by half, conserve resources (PPE, staffing, testing), decrease patient visits/potential COVID exposures, and reduce inpatient strain (bed, staffing). The chosen fractionation was the most hypo-fractionated scheme endorsed by the American Brachytherapy Society guidelines [2], and was a suggested approach in several guidelines written to lessen resource consumption in CC brachytherapy during the global pandemic [3][4][5].…”

Section: Purposementioning

confidence: 99%

Single application hybrid interstitial brachytherapy for cervical cancer: An institutional approach during the COVID-19 pandemic

Damast¹,

Tien²,

Young³

et al. 2022

jcb

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Purpose: To ease anesthesia and inpatient strain during the COVID-19 pandemic, our institution's policy for hybrid intracavitary-interstitial brachytherapy (IC/ISBT) for cervical cancer (CC) was modified from multiple applications (MA) treated over 2 separate weeks (7 Gy × 4) to a single-application (SA), treated within 1 week (8 Gy × 3). Here, we assessed dosimetric quality of the SA hybrid IC/ISBT approach and report our early outcomes.Material and methods: This was an IRB-approved retrospective review of CC patients treated with magnetic resonance imaging (MRI)-guided hybrid IC/ISBT between April 1, 2020 and December 31, 2020 (COVID cohort). Treatment parameters and quality indicators were compared to hybrid IC/ISBT cases treated in 2 years prior (pre-COVID cohort). Differences between cohorts were evaluated with the Mann-Whitney U-test.Results: In the COVID compared to pre-COVID cohort, median high-risk clinical target volume (HR-CTV) was similar: 33.3 vs. 33.9 cc, as was cumulative HR-CTV D 90% : 81.2 vs. 80.9 Gy. Organ-at-risk D 2cc values and recto-vaginal point doses were similar. Median number of channels loaded was increased to 6 vs. 4 (p = 0.002), but percentage of total dwell time allocated to needles remained similar: 13% vs. 15%. Median implant HR-CTV D 90% was higher: 107.8% vs. 98.4% (p = 0.001), and there was a trend toward reduced overall treatment time (OTT): 44 days vs. 53 days (p = 0.1). Local control was achieved in all patients, but mucosal toxicity was higher in the COVID group, with grade 2 or higher vaginal, genitourinary, or gastrointestinal events recorded in 56% of the patients. Conclusions:The SA hybrid IC/ISBT approach utilized during the COVID-19 pandemic maintained similar plan characteristics as pre-pandemic MA hybrid cases, while simultaneously reducing anesthesia, inpatient resources, and OTT. Local control outcomes demonstrate the regimen was effective; however, given the increased risk of mucosal toxicity, we conclude that the SA regimen should be considered only when a MA schedule is not feasible.

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Brachytherapy in cervical cancer radiotherapy during COVID-19 pandemic crisis: problems and prospects

Cited by 11 publications

References 16 publications

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Impact of COVID-19 on Outcomes for Patients With Cervical Cancer in India

Single application hybrid interstitial brachytherapy for cervical cancer: An institutional approach during the COVID-19 pandemic

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