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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 847-848

Authors' reply to Hanasoge et al. and Srinivas et al

Department of Radiotherapy, Mahavir Cancer Sansthan, Patna, Bihar, India

Date of Submission17-Oct-2020
Date of Decision20-Oct-2020
Date of Acceptance20-Oct-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Richa Chauhan
House N. N/35, Professor's Colony, Kankarbagh, Patna - 800 020, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_322_20

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How to cite this article:
Chauhan R, Trivedi V. Authors' reply to Hanasoge et al. and Srinivas et al. Cancer Res Stat Treat 2020;3:847-8

How to cite this URL:
Chauhan R, Trivedi V. Authors' reply to Hanasoge et al. and Srinivas et al. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 26];3:847-8. Available from: https://www.crstonline.com/text.asp?2020/3/4/847/304991

We thank Hanasoge and Stokes[1] and Srinivas et al.[2] for perusing our article on the practice of radiotherapy during the coronavirus disease 2019 (COVID-19) pandemic and drawing our attention to many pertinent points.[3],[4] We agree that as our study presents data from a single cancer center, the results cannot be generalized. It was an effort to compile the real-world data from our center with the hope that it could be included in a larger database from the region. The suggestion for additional information on overall treatment time and other details for patients with head-and-neck and cervical cancers by Srinivas et al. is well noted and will be incorporated in further site-wise analyses for the four common cancer types seen in our patients, namely head-and-neck, cervical, breast, and gastrointestinal cancers.

A better compliance rate seen during the pandemic (after excluding the patients who did not start radiotherapy) was surprising even for us. A possible reason could be that the local patients who turned up for radiotherapy were motivated to complete their cancer treatment. In addition, during this period, we also treated many patients who had returned from other centers in the metropolitan cities as our center had comparatively fewer cases of COVID-19. Moreover, the use of single-fraction palliative radiotherapy that allowed for treatment completion on the same day also could have contributed to the increased compliance.

We agree with the comments of Hanasoge et al. that the use of hypofractionated radiotherapy has its own radiobiological advantages and reduces the number of hospital visits for the patients.[5] We use the 3-week hypofractionated radiation protocol 40 Gy/15 fractions routinely in all patients with breast cancer. However, we have our reservations regarding the use of the more extreme hypofractionated 1-week radiation protocol used in the landmark FAST-FORWARD trial as our patient cohort was considerably different from that included in the study.[6] The FAST-FORWARD trial included patients with early breast cancer in whom nodal radiotherapy was not allowed, and 93.3% of the patients had undergone a breast-conserving surgery requiring only whole-breast radiation. In contrast, most of our patients had locally advanced disease and underwent modified radical mastectomy after neoadjuvant chemotherapy, requiring nodal radiation to the supraclavicular fossa along with chest wall irradiation.

We were in the early phase of the COVID-19 pandemic at the time of this study, as defined in the recent ASTRO-ESTRO guidelines for head-and-neck cancers. There was a strong agreement among the participants contributing to the ASTRO-ESTRO recommendations favoring no change in the fractionation schedule during the early phase of the pandemic.[7] Similarly, we also continued with the pre-pandemic fractionation schedule for patients with head-and-neck cancer requiring adjuvant or radical radiation. We were also concerned about the increased need for nasogastric feeding tube placement or percutaneous endoscopic gastrostomy in case the patients experienced higher toxicities to concurrent chemotherapy and hypofractionated radiotherapy.

We agree with Hanasoge et al. and follow a similar protocol for patients requiring palliative radiotherapy during the pandemic. They are prioritized and given abbreviated treatment courses as soon as possible.


We would like to thank the Department of Radiotherapy, Mahavir Cancer Sansthan, Patna.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Hanasoge S, Stokes WA. Caught in the middle: Cancer and COVID-19 risk for patients undergoing radiation therapy during the pandemic. Cancer Res Stat Treat 2020;3:844-6.  Back to cited text no. 1
  [Full text]  
Srinivas KK, Alva RC, Janaki MG. Can a pandemic put a spanner in the radiotherapy workflow? Cancer Res Stat Treat 2020;3:846-7.  Back to cited text no. 2
Richa C, Vinita T, Rita R, Usha S, Vasudha S, Santosh S, et al. The impact of COVID-19 pandemic on the practice of radiotherapy: A retrospective single-institution study. Cancer Res Stat Treat 2020;3:467-74.  Back to cited text no. 3
Sinha S, Laskar SG. Radiotherapy during the COVID-19 pandemic: What we know and what we practice after four months. Cancer Res Stat Treat 2020;3:574-6.  Back to cited text no. 4
  [Full text]  
Hall EJ, Giaccia AJ. Chapter 23: Time, Dose and Fractionation in Radiotherapy. Radiobiology for the Radiologist. 8th ed. Philadelphia:Wolters Kluwer; 2019  Back to cited text no. 5
Murray Brunt A, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-FORWARD): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 2020;395:1613-26.  Back to cited text no. 6
Thomson DJ, Palma D, Guckenberger M, Balermpas P, Beitler JJ, Blanchard P, et al. Practice recommendations for risk-adapted head and neck cancer radiation therapy during the COVID-19 pandemic: An ASTRO-ESTRO consensus statement. Int J Radiat Oncol Biol Phys 2020;107:618-27.  Back to cited text no. 7


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