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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 323-324

Head-and-neck cancer management in the COVID-19 era: Practice recommendations


Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

Date of Submission02-May-2020
Date of Decision04-May-2020
Date of Acceptance05-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Arvind Krishnamurthy
Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Adyar, Chennai . 600 036, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_167_20

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How to cite this article:
Krishnamurthy A. Head-and-neck cancer management in the COVID-19 era: Practice recommendations. Cancer Res Stat Treat 2020;3:323-4

How to cite this URL:
Krishnamurthy A. Head-and-neck cancer management in the COVID-19 era: Practice recommendations. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Sep 18];3:323-4. Available from: http://www.crstonline.com/text.asp?2020/3/2/323/287217



I read with interest the two manuscripts published in the COVID supplement issue of Cancer Research, Statistics, and Treatment, pertaining to the management of head-and-neck cancers.[1],[2] There are, in fact, a few recent guidelines available for the management of various cancers, including head-and-neck cancers, among the COVD-19 pandemic; however, almost all of them are based on expert opinion and consensus.[3],[4],[5] The COVID-19 pandemic and the resultant national lockdown have led to a considerable decrease in patient footfalls across all cancer centers in India, and a similar trend has been observed in both the studies.[1],[2]

The inclusion of real-world patient data for the very first time from a premier medical oncology division of the largest cancer center in India by Patil et al.[1] is indeed refreshing. A vast majority of the guidelines suggest not postponing the treatment in patients negative for COVID-19 in the early stages of the pandemic unless there are significant clinical reasons to consider a deviation.[3],[4],[5],[6] The same was observed in the study of pattern of care, wherein the intention to treat and the distribution of patients across the various treatment groups did not significantly change in the three subgroups, i.e., pre-COVID, start-COVID, and established-COVID. The two striking observations in the study were pertaining to the choice of systemic agents in the neoadjuvant as well as palliative care settings across the three subgroups. The cancer center that the authors are affiliated with, has landmark publications[7],[8] related to the use of oral metronomic chemotherapy (OMC) and this was logically the preferred regimen for the palliative settings. OMC has also been used by the authors in the neoadjuvant setting; interestingly, no patient received OMC in the start-COVID setting.

The recommended regimen of choice for neoadjuvant chemotherapy in head-and-neck cancers is the three-drug regimen – docetaxel, cisplatin, 5-fluorouracil (TPF). This regimen, although known to be toxic even in times prior to the COVID-19 era, can be handled by a seasoned medical oncologist. A few studies have shown a higher risk of immunosuppression and mortality when compared with the standard regimen of cisplatin (100 mg/m 2, once in 3 weeks)-based concomitant chemoradiation. The authors have therefore rightly advised caution while using the TPF regimen and explored the other neoadjuvant options in the times of COVID-19. This understanding is also crucial for the head-and-neck surgeons, who may wish to explore the option of neoadjuvant chemotherapy with TPF for locally advanced head-and-neck cancers, in an attempt to triage their surgical patients.

The other article in the journal by Dhar and Datta [2] highlights the salient recommendations made by various national as well as international societies for the management of head-and-neck cancers during the COVID-19 pandemic. It additionally highlights the enormous challenges faced across the national health-care systems, both governmental as well as private. The authors have rightly endorsed the need for having a multidisciplinary consult while making many complex decisions, especially with regard to the triaging of the patients with cancer across all stages, rather than relying on individual decisions.

In summary, the articles will help the oncologists managing head-and-neck cancers make personalized management decisions in the presence of the unrelenting pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patil VM, Srikanth A, Noronha V, Joshi A, Dhumal S, Menon N, et al. The pattern of care in head-and-neck cancer: Comparison between before and during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:7-12.  Back to cited text no. 1
    
2.
Dhar H, Datta S. Experience of treating head and neck cancers in government and private health-care systems during the COVID-19 pandemic: A viewpoint with summary of existing guidelines. Cancer Res Stat Treat 2020;3 Suppl S1:123-6.  Back to cited text no. 2
    
3.
Patil V, Noronha V, Chaturvedi P, Talapatra K, Joshi A, Menon N, et al. COVID-19 and head and neck cancer treatment. Cancer Res Stat Treat 2020;3 Suppl S1:15-28.  Back to cited text no. 3
    
4.
Chaves AL, Castro AF, Marta GN, Junior GC, Ferris RL, Giglio RE, et al. Emergency changes in international guidelines on treatment for head and neck cancer patients during the COVID-19 pandemic. Oral Oncol 2020;107:104734.  Back to cited text no. 4
    
5.
Krishnamurthy A, Gopinath KS. The need for prioritizing cancer surgeries amidst the COVID19 pandemic. Indian J Surg Oncol 2020; Apr 29;1-2[doi.org/10.1007/s1319302001080z].  Back to cited text no. 5
    
6.
You B, Ravaud A, Canivet A, Ganem G, Giraud P, Guimbaud R, et al. The official French guidelines to protect patients with cancer against SARS-CoV-2 infection. Lancet Oncol 2020;21:619-21.  Back to cited text no. 6
    
7.
Patil VM, Noronha V, Joshi A, Muddu VK, Dhumal S, Bhosale B, et al. A prospective randomized phase II study comparing metronomic chemotherapy with chemotherapy (single agent cisplatin), in patients with metastatic, relapsed or inoperable squamous cell carcinoma of head and neck. Oral Oncol 2015;51:279-86.  Back to cited text no. 7
    
8.
Patil VM, Noronha V, Joshi A, Dhumal S, Mahimkar M, Bhattacharjee A, et al. Phase I/II study of palliative triple metronomic chemotherapy in platinum-refractory/early-failure oral cancer. J Clin Oncol 2019;37:3032-41.  Back to cited text no. 8
    



This article has been cited by
1 Authorsę reply to Krishnamurthy, Bhosale et al., and Mohan et al.
Vijay Patil,Kumar Prabhash
Cancer Research, Statistics, and Treatment. 2020; 3(2): 327
[Pubmed] | [DOI]



 

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