In the face of COVID-19, considerations and procedures regarding the use of radiation for blood cancer patients may need to be modified.
When the risk of severe infections from COVID-19 begin to outweigh radiotherapy benefits, omitting the radiotherapy may be the best decision.
A recent article in the publication Cancer Network quoted researchers as saying that the guidelines are especially applicable to two groups. That would be people over sixty years of age and people who had other medical conditions (comorbidities).
The recommendations were presented by The International Lymphoma Radiation Oncology Group (ILROG). The group suggested three strategies that may reduce the demand for radiation treatments during the COVID-19 pandemic. That would involve delaying, omitting, or shortening the course of the radiotherapy.
The ILROG emphasized lowering toxicity, exposing the patients to minimal viral risk, and reducing the utilization of critical resources.
The group’s focus was on safety and efficacy while increasing the dose for each fraction and at the same time decreasing daily treatments. A dose of external radiation therapy is divided into fractions (smaller doses).
In addition, the ILROG offers the substitution of radiotherapy to target a specific area which can delay the need for radiation targeting the entire body.
Note that radiation therapy or radiotherapy uses various types of radiation to treat cancer as well as other diseases.
The doctors caution that if increased chemotherapy is used as a substitute for radiotherapy, it could result in suppression of the immune system and an inability to fight infection (immunosuppression). This is not the most ideal situation during a pandemic. Therefore, doctors must proceed on a case by case basis.
Researchers indicated that delaying radiotherapy may be an option as long as there are no anticipated adverse effects as a result of the delay.
An example of an appropriate delay would be if a patient became infected with COVID-19 before starting radiotherapy. As long as the malignancy has not progressed, it may be feasible to delay until the patient is clear of the COVID-19 infection.
Other examples that might be appropriate for a delay might be treating low-grade lymphomas or localized slow-growing nodular Hodgkin lymphoma.
If the determination is made to shorten a course of radiotherapy, the ILROG recommends the use of larger fractions. This is called hypofractionation.
When shortening the course of radiotherapy, the goals of avoiding toxicity, striving for a cure and optimum quality of care should be first and foremost. There are risks to this approach so the decision must be carefully thought out.
The ILROG guidelines are offered for consideration during the COVID-19 pandemic for patients with evidence of hematological malignancies.
The main objectives are to limit staff and patient exposure through the reduction of daily visits and maintain safety and efficacy. There are other options which may be chosen by the physician and patient that are well within the ILROG guidelines.