COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation

Abstract

PURPOSE:The purpose of this study was to highlight the importance of timely brachytherapy treatment for patients with gynecologic, breast, and prostate malignancies, and provide a framework for brachytherapy clinical practice and management in response to the COVID-19 pandemic. METHODS AND MATERIALS: We review amassing evidence to help guide the management and timing of brachytherapy for gynecologic, breast, and prostate cancers. Where concrete data could not be found, peer-reviewed expert opinion is provided. RESULTS: There may be a significant negative impact on oncologic outcomes for patients with gynecologic malignancies who have a delay in the timely completion of therapy. Delay of prostate or breast cancer treatment may also impact oncologic outcomes. If a treatment delay is expected, endocrine therapy may be an appropriate temporizing measure before delivery of radiation therapy. The use of shorter brachytherapy fractionation schedules will help minimize patient exposure and conserve resources. CONCLUSIONS: Brachytherapy remains a critical treatment for patients and may shorten treatment time and exposure for some. Reduced patient exposure and resource utilization is important during COVID-19. Every effort should be made to ensure timely brachytherapy delivery for patients with gynecologic malignancies, and endocrine therapy may help temporize treatment delays for breast and prostate cancer patients. Physicians should continue to follow developing institutional, state, and federal guidelines/recommendations as challenges in delivering care during COVID-19 will continue to evolve.

The Impact of COVID-19 on Brachytherapy During the Pandemic: A Rutgers-Robert Wood Johnson Barnabas Health Multisite Experience

“…It is interesting to note that although a majority of the patients studied had vascular and/or respiratory comorbidities, deeming them in the high-risk category if infected with SARS-CoV-2, most still proceeded with treatment and did not try to delay or cancel out of fear. Several publications from experts in brachytherapy tackled the challenges of delivering brachytherapy during the pandemic and made recommendations for risk mitigations ( 6 , 8 , 9 , 10 , 11 ).…”

“…Although there is limited data on the optimal timing of vaginal cuff brachytherapy (VBT) after surgery for uterine cancer, the experts recommend delivering VBT in ≤ 8 weeks after surgery but no more than 12 weeks ( 11 ). Four patients cancelled their brachytherapy and despite many phone calls, opted not to resume treatment.…”

“…It appears that definitive treatment for prostate cancer can be postponed without impact on clinical outcomes ( 18 , 19 , 20 , 21 , 22 ). Experts have suggested that prostate cancer treatment can safely be deferred for 3-6 months ( 6 , 11 ). For patients with high-risk prostate cancer, continuing or initiating ADT is recommended until brachytherapy can be delivered.…”

“…For patients with high-risk prostate cancer, continuing or initiating ADT is recommended until brachytherapy can be delivered. If a patient is requiring a brachytherapy boost, initiating ADT and delaying start of EBRT is recommended ( 11 ). In our small cohort, we were able to deliver the entire course of EBRT to all patients with prostate cancer without delays.…”

https://researchopenworld.com/management-of-cancer-patients-undergoing-radiation-therapy-during-the-novel-coronavirus-disease-2019-covid-19-pandemic-a-review-of-the-literature/#

“…Williams et al provide a thorough review of the impact of delaying or prolonging brachytherapy treatment courses in multiple disease sites including gynecological sites, prostate and breast [19]. While the timing and duration of brachytherapy is highly sensitive in sites like cervix and vaginal cancer, breast and in particular prostate may allow for some postponement of brachytherapy.…”