Management of breast cancer during COVID‐19 pandemic in Morocco

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

“… If the boost is necessary: - postponed up to 3 months for high-risk patients and up to 6 months for low-risk patients Delay of definitive radiotherapy for good-risk tumors HR+, HER2- (Adjuvant setting): 42.6 Gy / 16 frs or 40 Gy / 15 frs (Hypo-F RT) ( Raghavan et al, 2020 ) Postop RT: for several weeks or even months Adjuvant local RT in early-stage breast cancer: 26 Gy /5 frs over 1 week is non-inferior to 40 Gy / 15 frs over 3 weeks for (UK FAST-forward trial) ( Upadhyay and Shankar, 2020 ) boost RT in selected patients adjuvant RT: up to 3 months after surgery Hypo-F RT for adjuvant treatment ( Ng et al, 2020a ) Certain non-invasive carcinomas with good prognosis factors (Age > 40 yrs, tumors < 2.5 cm, low and intermediate grade, and sufficient surgical margins ≥ 2 mm) Age > 65 yrs (or with comorbidities) with invasive BC with good prognostic factors (grade 1-2, hormone-positive, tumors < 3 cm, Node-, HER2-) Boost for patients > 40 yrs without risk factors (LVI, high grade, hormone-negative, and positive surgical margins) adjuvant RT: -low-risk disease -In-situ carcinoma (CIS) by 3-6 months For postmenopausal patients > 65 yrs with stage I or II and hormone-dependent disease, or patients with significant comorbidities: by 3 to 6 months Adjuvant RT for high-risk BC: -Stages T3 or N-positive -Stages T1/T2N0 with risk factors (LVI, high grade, margins+, and HR-) Hypo-F RT: 42 Gy / 15 frs Ultra Hypo-F RT: 28/30-Gy in once weekly fractions over 5 weeks or 26-Gy in 5 daily fractions over 1 week as per the FAST and FAST Forward trials (N- tumors without boost). ( Ismaili and El Majjaoui, 2020 ) Boost: age > 50 yrs with ER+, HER-2- invasive type tumor without other adverse pathologic features Standard BCS RT: age > 70 yrs with small, grade I-II, and HR + tumor RT after excision for low-intermediate grade DCIS, particularly in women over 60 yrs Adjuvant RT: Hypo-F RT (42.4 Gy /16 frs or 40 Gy / 15 frs) and standard regimen (50 Gy / 25 frs) for regional lymph nodes involvement ( Mahmoodzadeh et al, 2020 ) After BCS: - Low-risk elderly (≥ 65 yrs): WBRT for stage I, ER+/HER2− receiving adjuvant endocrine therapy, without impacting survival - DCIS: WBRT, especially for ER + disease receiving adjuvant endocrine therapy, without affecting overall survival. - Invasive disease with low-risk genomic profile -Boost: in invasive disease (except for patient ≤40 yrs or with positive margin) and in situ (except for positive margin; no survival benefit except for high-risk disease After mastectomy: T1-2 N+ Low-risk elderly (≥65 yrs): WBRT...…”

The Novel Coronavirus (COVID-19) Pandemic and the Response in Low-to-Middle Income Countries

“…It was suggested that adjuvant radiation therapy be delayed for low-risk disease and hypofractionated RT be preferred for patients in whom radiation cannot be postponed. They further proposed the use of oral therapies for metastatic breast cancer patients [ 27 ] and replacing physical consultations with teleconsultations. For patients receiving palliative care, they recommended planning therapeutic spacing/de-escalation whenever possible.…”

COVID-19 Recommendations for Patients with Cancer: The post-COVID-19 Era

“…The decision on the priorities for surgery should be undertaking in a multidisciplinary team (MDT) meeting in accordance with recommendations established by national and international societies [3,4,7,8]. The possibility of adapting the treatment sequence will depend on the disease stage and the acceptable time to defer surgery.…”

“…Teleconsultation has become a new opportunity for triage of patients into those who should be physically examined, and those who should benefit from additional workup before their admission physically to limit their exposure to the hospital environment and therefore to reduce their risk of contamination. The main limitation of teleconsultation during follow-up is the impossibility of examining patients, but as long as the epidemic situation is not controlled, teleconsultation remains preferable [3][4][5][7][8][9].…”

“…During the COVID-19 pandemic, national and international societies recommend continuing the management of cancer patients despite the spread of the virus in the world. They established guidelines to adapt patient care and to limit the risk of contamination by the virus while preserving their chances of recovery [2][3][4][5][6][7] (http://smc.ma/recommandation-cancer-etcovid-19-smc/). For example, Table 1 summarizes special recommendations implemented for patients diagnosed with breast cancer during the COVID-19 pandemic [4].…”