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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 849-850

Are we radiation avid for head-and-neck cancer during the COVID-19 pandemic?


Department of Radiation Oncology, Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Submission01-Oct-2020
Date of Decision10-Oct-2020
Date of Acceptance10-Oct-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Janaki Gururajachar Manur
Department of Radiation Oncology, Ramaiah Medical College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_307_20

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How to cite this article:
Manur JG, Agrahara Srinivas KK, Alva RC. Are we radiation avid for head-and-neck cancer during the COVID-19 pandemic?. Cancer Res Stat Treat 2020;3:849-50

How to cite this URL:
Manur JG, Agrahara Srinivas KK, Alva RC. Are we radiation avid for head-and-neck cancer during the COVID-19 pandemic?. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 25];3:849-50. Available from: https://www.crstonline.com/text.asp?2020/3/4/849/304980



Radiation plays a vital role in the treatment of patients with head-and-neck cancers as it offers the advantage of function preservation. The article by Sinha et al. provides practical suggestions for radiotherapy in patients with head-and-neck cancers during the coronavirus disease 2019 (COVID-19) pandemic.[1] However, unlike the author's center, in several places, the department of radiation oncology is a part of medical colleges which have been designated as COVID-care hospitals following the government's initiative. This has led to various logistic issues such as the nonavailability of beds in the intensive care unit and issues with surgery and chemotherapy which have a direct bearing on the treatment and outcomes of patients with cancer.

Even though every patient is tested for COVID-19 before starting radiotherapy, it is not clear as to how often they should be tested during the 6–7 weeks of radiation. It is fair to monitor the patients closely with a high degree of suspicion, and testing can be done as and when deemed necessary. This can be challenging as the symptoms of COVID-19 and radiation sequelae overlap. With fewer surgeries being performed during the pandemic, many patients with oral cavity cancers will likely be referred for radiation. It is important to categorize the patients as early and otherwise operable who can be taken up for curative therapy or advanced and inoperable who could be offered short-course palliative radiation with best supportive care. In very selected cases brachytherapy alone with all precautions could reduce the overall treatment time (OTT).

Although the authors have suggested a dose of 2.2 Gy/Fr with a reduction of the OTT by a week, it is necessary to consider the planning target volume and decide the dose as the associated toxicities may be higher,[2] thereby necessitating the hospitalization of the patients for supportive care.

It is best to avoid concurrent chemotherapy in patients with uncontrolled comorbidities, lack of good support systems and in older patients as suggested by the authors. Our thoughts on induction chemotherapy (IC) are different from those of the authors. As such, in our country, the compliance to IC is not encouraging. Prolonged myelosuppression is observed[3] and in the absence of higher level of evidence, we would not consider IC just to postpone surgery, the definitive treatment.

We have observed that during this pandemic a greater proportion of the patients present with a more advanced disease. Therefore, we would prefer to use IMRT for all the patients as it has a better therapeutic ratio. In addition, staggered working hours for the technologists, strict adherence to appointments and only one attendant per patient could help minimize the spread of infection. Another important concern is the cross infection between patients as the accessories such as base plate, head rest, and clamps are used for everyone, and it can be challenging to disinfect all the accessories. Therefore, changing the sheets alone will not suffice, and all possible measures listed in the standard guidelines should be followed.[4],[5] During the follow-up, we would prefer to avoid or defer any investigations and rely mostly on the symptoms and clinical examination.

The pandemic is likely to stay for longer than expected, and we believe in “no one size fits all.” Therefore, in addition to the guidelines, finding innovative solutions to unique situations and sharing them with colleagues can go a long way in providing optimal care across our country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sinha S, Laskar SG, Mummudi N, Budrukkar A, Swain M, Agarwal JP. Head-and-neck cancer radiotherapy recommendations during the COVID-19 pandemic: Adaptations from the Indian subcontinent. Cancer Res Stat Treat 2020;3:424-6.  Back to cited text no. 1
  [Full text]  
2.
Manur JG, Vidyasagar N. Correlation of planning target volume with mucositis for head-and-neck cancer patients undergoing chemoradiation. J Cancer Res Ther 2020;16:565-8.  Back to cited text no. 2
    
3.
Thomson DJ, Palma D, Guckenberger M, Balermpas P, Beitler JJ, Blanchard P, et al. Practice recommendation for risk adopted head and neck cancer radiation therapy during COVID-10 pandemic: An ASTRO-ESTRO consensus statement. Int J Radiat Oncol Biol Phys 2020;107:618-27.  Back to cited text no. 3
    
4.
Tsang Y, Duffton A, Leech M, Rossi M, Scherer P, ESTRO RTTC. Meeting the challenges imposed by COVID-19: Guidance document by the ESTRO Radiation TherapisT Committee (RTTC). Tech Innov Patient Support Radiat Oncol 2020;15:6-10.  Back to cited text no. 4
    
5.
Kulkarni T, Sharma P, Pande P, Agrawal R, Rane S, Mahajan A. COVID-19: A review of protective measures. Cancer Res Stat Treat 2020;3:244-53.  Back to cited text no. 5
  [Full text]  




 

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