COVID-19 and Gynecological Cancers: A Summary of International Recommendations

Abstract

Morocco and the rest of the world are experiencing a pandemic of a new coronavirus known as COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). On August 24, 2020, the spread of the virus in Morocco had caused more than 52,000 cases and 880 deaths. Cancer patients are more susceptible to develop an infection than people without cancer because of their immunosuppression caused by the disease and treatments (surgery and chemotherapy). Therefore, these patients are at higher risk of infection with COVID-19 and a much higher risk of developing more serious forms. Given this epidemiological context, the establishment of guidelines for patients with gynecological cancers, requiring multidisciplinary management during the global COVID-19 pandemic, is crucial to limit their infection while maintaining their chances for a cure. In this paper, we summarize the international COVID-19 recommendations on the prioritization of surgical cases, the perioperative protective measures, the precautions to be taken in the brachytherapy unit, the COVID-19 screening, and finally the therapeutic indications of gynecological cancers by tumor location.

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

“… 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 ( …”