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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 324-325

Adaptive approach toward the management of head-and-neck cancers during the COVID-19 crisis


1 Department of Oncology, Jaslok Hospital and Research Centre, Mumbai; Department of Oncology, Vedant Hospital, Thane; Department of Oncology, Bombay Hospital and Mefical Research Centre, Mumbai, Maharashtra, India
2 Department of Radiation Oncology, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India

Date of Submission07-May-2020
Date of Decision08-May-2020
Date of Acceptance09-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Bharat Bhosale
Department of Medical Oncology, Room No. 125, 1st Floor MRC Building, Bombay Hospital and Medical Research Centre, New Marine Lines, Mumbai - 400 020, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_178_20

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How to cite this article:
Bhosale B, Katna R, Kalyani N. Adaptive approach toward the management of head-and-neck cancers during the COVID-19 crisis. Cancer Res Stat Treat 2020;3:324-5

How to cite this URL:
Bhosale B, Katna R, Kalyani N. Adaptive approach toward the management of head-and-neck cancers during the COVID-19 crisis. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Aug 7];3:324-5. Available from: http://www.crstonline.com/text.asp?2020/3/2/324/287225



As we write this reply to Patil et al.'s article,[1] all the registered medical practitioners in Maharashtra have been asked by the government to come forward to work voluntarily for patients affected by the coronavirus disease 2019 (COVID-19). Therefore, there is a definite allocation of health-care resources to the COVID-affected population, and cancer care is on the back foot.[2]

The article [1] very well brings out the nuances of treatment of oral cancers with respect to the prevailing pandemic situation. The authors have highlighted the fact that early operable cancers should be treated with surgery, if feasible, to provide the optimum results.

We see majority of our patients in the locally advanced stage, and they usually require complex reconstruction procedures. Microvascular reconstructions are long procedures with an increased risk to the patient and health-care workers in the wake of the COVID-19 pandemic. Hence, there is an increased role of neoadjuvant chemotherapy (NACT) in these cancers. The use of NACT in head-and-neck squamous cell carcinoma is common in borderline-resectable head-and-neck cancers, based on the trials by Licitra et al. and the various retrospective data series.[3],[4],[5]

The current situation is unprecedented, and considering the risk involved in head-and-neck surgeries to health-care workers and the need for intensive care unit beds for postoperative care of such patients, surgeries are being deferred for an unpredictable period.[6] In such a scenario, NACT is the best option to prevent tumor progression and buy some time so that essentially curable patients do not become palliative. As rightly mentioned by the authors, the use of two drugs with the avoidance of 5-fluorouracil should be preferred, as it requires 5 days of infusion and may require admission for supportive care.

We believe that the use of metronomic chemotherapy is the key to address the problem of expert care not being easily available, such as in the remote areas where frequent hospital visits are not possible because of the sealed district borders or in the containment zones in the metro cities.[7],[8] The use of immunotherapy is not very prevalent in the NACT setting. It can be used with modified schedules in a selected class of patients,[9] who have immediate access to emergency care facilities.

Oropharyngeal malignancies in our subcontinent are not overtly associated with the human papillomavirus (HPV).[10] Hence, it makes a fair point to offer them radiation rather than robotic surgery as a treatment option. The reasons for this are, firstly, the equal or better control rates with radiation therapy in HPV-negative oropharyngeal malignancies; secondly, the robotic procedures are long, thus increasing the risk to health-care providers, as the surgical team works on the console in the same operating room.

Radiotherapy will carry a lesser risk of spreading the infection and aerosol generation. However, the number of visits to radiotherapy facilities must be reduced by increasing the use of hypofractionation regimens, whenever clinically feasible.[11] Adjuvant radiotherapy may be omitted for borderline and soft indications, as pointed out in the article. We agree with the authors about the judicious use of resource-intensive radiation techniques such as intensity-modulated radiation therapy and arc therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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. 1
    
2.
Noronha V, Behel V. Catch-22: COVID versus Cancer. Cancer Res Stat Treat 2020;3 Suppl S1:1-2.  Back to cited text no. 2
    
3.
Patil VM, Prabhash K, Noronha V, Joshi A, Muddu V, Dhumal S, et al. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol 2014;50:1000-4.  Back to cited text no. 3
    
4.
Licitra L, Grandi C, Guzzo M, Mariani L, Lo Vullo S, Valvo F, et al. Primary chemotherapy in resectable oral cavity squamous cell cancer: A randomized controlled trial. J Clin Oncol 2003;21:327-33.  Back to cited text no. 4
    
5.
Goel A, Singla A, Prabhash K. Neoadjuvant chemotherapy in oral cancer: Current status and future possibilities. Cancer Res Stat Treat 2020;3:51-9.  Back to cited text no. 5
  [Full text]  
6.
Prem A, Patel S, Pai E, Pandey D. Surgical management of cancer during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:119-22.  Back to cited text no. 6
    
7.
Pai PS, Vaidya AD, Prabhash K, Banavali SD. Oral metronomic scheduling of anticancer therapy-based treatment compared to existing standard of care in locally advanced oral squamous cell cancers: A matched-pair analysis. Indian J Cancer 2013;50:135-41.  Back to cited text no. 7
  [Full text]  
8.
Patil VM, Srikanth A, Noronha V, Joshi A, Dhumal S, Menon N, Prabhash K. 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. 8
    
9.
Patil VM, Noronha V, Joshi A, Abhyankar A, Menon N, Banavali S, et al. Low doses in immunotherapy: Are they effective? Cancer Res Stat Treat 2019;2:54-60.  Back to cited text no. 9
  [Full text]  
10.
Murthy V, Calcuttawala A, Chadha K, d'Cruz A, Krishnamurthy A, Mallick I, et al. Human papillomavirus in head and neck cancer in India: Current status and consensus recommendations. South Asian J Cancer 2017;6:93-8.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Munshi A, Rastogi K. Management of cancer during the COVID-19 pandemic: Practical suggestions for the radiation oncology departments. Cancer Res Stat Treat 2020;3 Suppl S1:115-8.  Back to cited text no. 11
    



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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