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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 3
| Issue : 4 | Page : 850-851 |
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Authors' reply to Hanasoge et al. and Manur et al.
Shwetabh Sinha, Sarbani Ghosh Laskar
Department of Radiation Oncology, Tat Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| Date of Submission | 18-Oct-2020 |
| Date of Decision | 22-Oct-2020 |
| Date of Acceptance | 26-Oct-2020 |
| Date of Web Publication | 25-Dec-2020 |
Correspondence Address:
Sarbani Ghosh Laskar
Department of Radiation Oncology, Head and Neck Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai - 400 012, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/CRST.CRST_327_20
How to cite this article:
Sinha S, Laskar SG. Authors' reply to Hanasoge et al. and Manur et al.. Cancer Res Stat Treat 2020;3:850-1 |
We appreciate the comments from Hanasoge et al.[1] and Manur et al.[2] on our article titled “Head-and-neck cancer radiotherapy recommendations during the COVID-19 pandemic: Adaptations from the Indian subcontinent,” published in Cancer Research, Statistics, and Treatment.[3]
With respect to the issue raised by Manur et al. regarding the feasibility of the dose per fraction of 2.2 Gy for these cancers, we would like to clarify that this regimen has been adopted as a standard approach across multiple institutes as well as in multiple Radiation Therapy Oncology Group trials.[4] At the Tata Memorial Hospital, we have utilized a dose prescription of 66 Gy in 30 fractions (2.2 Gy per fraction) for definitive intensity-modulated radiation therapy in head-and-neck cancers over the past 10 years with excellent outcomes in terms of survival and toxicity.
We concur with Hanasoge et al. and Manur et al. that the pre-COVID-19 practices should not be changed with regard to the utilization of neoadjuvant chemotherapy. However, at our institution, we have utilized neoadjuvant chemotherapy for borderline, resectable tumors, and for mandibular preservation to aid in surgery and reduce morbidity for which there is evidence in literature.[5],[6],[7] Patients who are deemed upfront operable continue to be operated. Furthermore, as emphasized previously, no patient who requires primary surgical treatment in routine times should be treated with definitive radiation therapy, not even during the pandemic, unless there are fitness issues. Concurrent chemoradiation (wherever feasible) continues to be the standard approach for organ preservation for laryngopharyngeal cancers; however, with the limited yet growing body of evidence for the role of induction chemotherapy, we consider the latter approach on a case-to-case basis.[8] We do not suggest a change in practice with regard to the use of induction chemotherapy during the COVID-19 pandemic.
As the focus of our article was changes in the clinical practice in head-and-neck radiation therapy during the COVID-19 pandemic, it did not entail a detailed discussion on the administrative measures adopted at our institution for preventing cross infection among the patients and radiation therapy staff. However, an elaborate description of these steps has previously been published from our institution.[9],[10] We also acknowledge the comment by Manur et al. on the lack of consensus on testing before and during radiotherapy. As suggested previously, this policy should be individualized as per the prevailing scenario as well as the existing facilities, resources, and workforce.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Hanasoge A, 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.  [Full text] |
| 2. | Manur GJ, 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. [Full text] |
| 3. | 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. [Full text] |
| 4. | Eisbruch A, Harris J, Garden AS, Chao CK, Straube W, Harari PM, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys 2010;76:1333-8. |
| 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. [Full text] |
| 6. | 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. |
| 7. | 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. |
| 8. | Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, et al. Long-term results of RTOG 91-11: A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013;31:845-52. |
| 9. | Mummudi N, Tibdewal A, Ghosh-Laskar S, Agarwal JP. COVID-19 pandemic: Radiotherapy precautions and preparedness. J Cancer Res Ther 2020;16:634-7. |
| 10. | 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;3:15-28. [Full text] |
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