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Top Line: With shifting risk / benefit ratios in the current pandemic, prostate radiation needs to be re-thought.
The Study: Rad oncs from across the US and UK convened (virtually, of course) to quickly establish new norms for prostate cancer treatment in pandemic conditions. In doing so they coined the “RADS” framework which hinges on remote visits, avoidance of radiation, deferment of radiation, and shortening of radiation. As we don't know how much more we can talk about the first point, we’ll focus on how the "ADS" specifically pertains to prostate cancer. Here we must stop to applaud this group for an extremely user-friendly Table 1 that clearly outlines the group’s recommendations stratified by risk group, node-positivity, post-op status, and volume of mets. The summary is that low and favorable-intermediate risk cancers can be actively surveyed until post-pandemic, unfavorable-intermediate and high risk as well as node-positive and low-volume metastatic cancers can be delayed with 4-6 months of ADT, post-op adjuvant cases can wait until 120 days after surgery, and post-op salvage start depends on PSA value and doubling time. When treating, 5-fraction regimens are preferred for everyone except post-op cases where 20 fractions are preferred. Finally, there should be a particularly high threshold for employing anything that requires OR time, staff , and resources such as PPE equipment (e.g., fiducial and / or hydrogel placement or brachy procedures).
TBL: Rethink how you will approach prostate cancer cases in the coming weeks to months. | Zaorsky, Adv Radiat Oncol 2020