Prostate cancer: guidelines for radiotherapy during the COVID-19 pandemic

  • Zaorsky NG & al.
  • Adv Radiat Oncol
  • 1 Apr 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Patients with prostate cancer need radiotherapy plans that conserve resources and allow for their safe management during the COVID-19 pandemic.
  • A group of radiation oncologists from the United States and United Kingdom conducted a systematic review and agreed on a set of recommendations.

Key recommendations

  • Remote visits:
    • All visits should be transitioned to telehealth visits; few patients require an in-person visit.
  • Low- and favorable intermediate-risk disease:
    • Treatment can be safely deferred for up to 12 months because these patients have favorable outcomes with watchful waiting, active monitoring, or active surveillance.
  • Higher-risk disease:
    • Androgen-deprivation therapy (ADT) can allow for further deferral of radiotherapy for 4-6 months.
    • If ADT cannot be delivered, the benefits of immediate treatment during a window of potential cure must be weighed against COVID-19 exposure and subsequent morbidity and mortality in patients with rapid PSA doubling times (≤3 months).
    • Significant prolongation of ADT beyond standards of care should be avoided.
    • If treatment is deemed necessary and safe, the shortest fractionation schedule should be adopted.
    • Ultrafractionation should be used for intermediate- and high-risk localized prostate cancer.
    • For postprostatectomy patients, a moderate hypofractionated regimen is preferred.
    • Stereotactic body radiotherapy or 6 Gy × 6 fractions can be delivered for low-volume M1 disease.