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Top Line: Here’s a tough one: should anything change in definitive radiation for head and neck (H&N) cancers during a pandemic?
The Study: While certain disease sites have thinned considerably on many on-treatment rosters, the number of H&N cases referred for radiation are higher than ever amidst wide-spread operating room closures. This 31-author, 12-nation, ASTRO / ESTRO collaborative show of might is here to offer guidance. Analogous to the ASTRO / ESTRO lung cancer consensus, five common cases were explored for both early (risk mitigation) and late (resource depletion) pandemic scenarios. First, there was strong consensus that definitive treatment initiation of any M0 case should not be delayed nor should post-operative treatment in the setting of positive margins. For patients with active COVID-19, there was strong consensus to delay initiation until the patient tests negative; on the other hand, there was consensus to not interrupt treatment (particularly after the first two weeks) if the patient acquires COVID-19—the exception being severe symptoms precluding safe continuance of treatment. The use of non-standard hypofractionation was unpopular. In the risk-mitigation phase, there was a consensus to continue to employ standard fractionation and concurrent chemo. However, with severely reduced resources, hypofractionation must be employed and concurrent chemo used only with fraction sizes ≤2.4 Gy. Finally, with OR closures, there was agreement to wait for surgery in lieu of definitive radiation for oral cavity cancers if surgery can be done within 8 weeks for early-stage and within 4 weeks for advanced-stage disease.
TBL: Management of H&N cancers shouldn’t change unless resource shortages mandate it. | Thomson, Int J Radiat Oncol Biol Phys 2020