Background: With the pandemic gaining a firm foothold globally, various governments world-wide are trying hard to halt its unprecedented spread. The pandemic is challenging the healthcare professionals in unique ways and forcing the frontline fighters to come up with dynamic changes in almost all disciplines of medical science. This article is aimed at a detailed review of the exist-ing guidelines for radiotherapy practice during this pandemic from across the world. Methods: This review has been organised under specific subheadings that pertains to the functioning of a Radiation Oncology facility in South Asian countries like India. After a detailed Zoom video conference between the authors, it was decided to focus the review under the following sub-headings: staff allocation, staff education, screening of patients, patient waiting area modifica-tion, patient selection, radiotherapy planning and execution, review of patients on radiotherapy, brachytherapy, inpatient admissions, follow up, resident training and treatment of suspected or positive COVID 19 patients.Results: After discussion among the authors, a consensus working suggestion during the COVID-19 pandemic has been proposed for a radiotherapy center in a South Asian country like India. All the authors worked simultaneously on a Google doc docu-ment to develop this manuscript. Conclusions: This paper can be a reference document for the functioning of a radiotherapy facility during the COVID19 pandemic. As the infrastructure of different institutes vary and so does each patient, the importance of fine tuning and tailoring our final decisions before treating a patient in this unprecedented crisis cannot be undermined.
The COVID-19 pandemic has derailed the management of many cancers. Prostate cancer although a disease known for good response to treatment has posed unique challenges in this pandemic in view of the co-morbidities associated with these elderly patients. A pandemic specific treatment approach following the RADS (Remote, Avoid, Defer, Shorten) principle is required while dealing with these patients. Very low, low and favourable intermediate risk cancers may be kept on active surveillance rather than active treatment. Unfavourable intermediate, high and very high risk cases may follow the ‘defer’ policy by initiating hormonal therapy for 6-8 months to defer radiotherapy. When radiation is planned for these patients extreme or moderate hypo fractionation may be used to follow the ‘shorten’ policy. Metastatic hormone sensitive cancers may be initiated on hormonal therapy avoiding antiandrogens like Abiraterone and chemotherapy upfront. In the castration resistant phase the antiandrogens like Abiraterone or Enzalutamide may be given preference over chemotherapy. In the post operative settings early salvage may be preferred over adjuvant that too, using hypofractionation. Symptomatic patients require prompt attention and radiation should not be delayed for palliation of impending spinal compression or fracture or for local symptoms. Aggressive histologies like small cell types also need prompt treatment. Other general measures like universal masking, hand hygiene, physical distancing, respiratory etiquettes, etc., must also be emphasised keeping in mind the vulnerability of these patients.
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