Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations

Abstract

Objective To develop expert consensus recommendations regarding radiation therapy for gynecologic malignancies during the COVID-19 pandemic. Methods An international committee of ten experts in gynecologic radiation oncology convened to provide consensus recommendations for patients with gynecologic malignancies referred for radiation therapy. Treatment priority groups were established. A review of the relevant literature was performed and different clinical scenarios were categorized into three priority groups. For each stage and clinical scenario in cervical, endometrial, vulvar, vaginal and ovarian cancer, specific recommendations regarding dose, technique, and timing were provided by the panel. Results Expert review and discussion generated consensus recommendations to guide radiation oncologists treating gynecologic malignancies during the COVID-19 pandemic. Priority scales for cervical, endometrial, vulvar, vaginal, and ovarian cancers are presented. Both radical and palliative treatments are discussed. Management of COVID-19 positive patients is considered. Hypofractionated radiation therapy should be used when feasible and recommendations regarding radiation dose, timing, and technique have been provided for external beam and brachytherapy treatments. Concurrent chemotherapy may be limited in some countries, and consideration of radiation alone is recommended. Conclusions The expert consensus recommendations provide guidance for delivering radiation therapy during the COVID-19 pandemic. Specific recommendations have been provided for common clinical scenarios encountered in gynecologic radiation oncology with a focus on strategies to reduce patient and staff exposure to COVID-19.

Considerations for the Care of Women with Gynecological Cancers during the COVID-19 Pandemic

“…Adjuvant radiation may be deferred by up to 8 to 12 weeks if necessary, depending on the clinical scenario. 10…”

“…8,9 Patients with endometrioid histology can be considered for hormonal therapy, if necessary, and radiation can be deferred. 10 Following surgery, adjuvant radiation therapy can be delayed between 6 to 8 weeks. 10 It may be prudent to reduce the number of radiotherapy fractions and/or whenever deemed necessary, use chemotherapy judiciously, preferring regimens which are less toxic, and avoid frequent patient visits.…”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…Hypofractionation schedules should be considered whenever feasible, and brachytherapy should not be delayed. 113 All treatment should be preferably completed within 8 weeks, and delays should be avoided since they impact local control and survival.…”

“…111,112 Hormonal therapy may be used in patients with endometrioid histology if adjuvant radiation needs to be delayed. 113 Adjuvant radiation therapy may be delayed between 6 and 8 weeks following surgery in most cases. 113 Adjuvant therapy might be deferred during the crisis in stage-I or -II disease with low-risk features, where as in cases with intermediate to high-risk features, Brachytherapy is preferred considering fewer hospital visits and lesser risk of complication.…”

“…113 Adjuvant radiation therapy may be delayed between 6 and 8 weeks following surgery in most cases. 113 Adjuvant therapy might be deferred during the crisis in stage-I or -II disease with low-risk features, where as in cases with intermediate to high-risk features, Brachytherapy is preferred considering fewer hospital visits and lesser risk of complication. 112 External beam radiotherapy with or without chemotherapy should be considered without any delay after surgery in high-risk patients and also for patients with symptomatic unresectable primary tumor not suitable for surgery.…”