key: cord-0928579-h9ojgy5q
authors: de Andrade Vieira, Marcelo; Araujo, Raphael L.C.
title: Management of Gynaecological oncology diseases during COVID-19 global pandemic
date: 2020-04-18
journal: Eur J Surg Oncol
DOI: 10.1016/j.ejso.2020.04.022
sha: df54cb926de88e899d7b74544c040beaf564057f
doc_id: 928579
cord_uid: h9ojgy5q

nan

Since the first reported cases of COVID-19 in China at the end of 2019, the world is experiencing a devastating crisis with negative expectations in all scenarios. (1) (2) (3) Due to the immediate adaptations that the health system needs to make, concerns about cancer diseases, especially gynaecologic cancer diseases, arise. (3) Several medical societies worldwide have mobilized and attempted to create recommendations for the moment of crisis of COVID-19 without jeopardizing the cancer treatments. (3) We have tried to gather the published recommendations related to the treatment of gynaecological cancer in an effort to assist the management of these patients in different health services worldwide. (2) (3) (4) Considering that the world population is heterogeneous in terms of the incidence of gynaecological tumours, both access to health services and the contamination rates by are also varied, these recommendations suggest local adaptations. (2) Cervical tumours: it is recommended to postpone the treatment of pre-invasive lesions for 6 to 12 months. Initial invasive lesions or low risk (<2 cm, favourable histologies) should be considered the standard treatment and, in places with limited access to surgery, consider conisation or simple trachelectomy with sentinel lymph node research and reassess it in 3 months or at the end of the crisis. In the desire to preserve fertility with bulky lesions, neoadjuvant chemotherapy should be considered. Resectable and advanced cases should follow standard treatment with the suggestion of hypofractionation of radiotherapy doses (to decrease visits to the service). And, in cases of asymptomatic patients for COVID-19, brachytherapy should not be delayed. (2, 4) Endometrial tumours: Perform outpatient hysteroscopies only for highly suspect patients. Vaginal tumours: most of them are in advanced stages. Therefore, radiotherapy and chemotherapy, when indicated, remains the best option. (2, 4) Trophoblastic tumours: due to the excellent potential to achieve cure, and a high chance of metastases at diagnosis, the systemic therapy with usual treatment should be considered. (4) Visits to the doctor should be restricted to new diagnoses, to immediate postoperative follow-up, or in case of urgency and emergency due to symptoms. (1) The use of telemedicine is essential at this time for cancer follow-up, and the decision to manage cancer must take into consideration the patient's location (local epidemiological studies can help these decision), age of the patient, associated comorbidities, disease staging, tumour histology, and rates of potential postoperative complications. Considering that the joint decision about treatment in multidisciplinary tumour boards (online video conferencing) is crucial for the division of responsibilities in decisions.

(2,4)

Drs. Marcelo Vieira and Raphael Araújo have no conflicts of interest or financial ties to disclose.

There is no conflict of interest of any of the authors.

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

COVID-19 Global Pandemic: Options for Management of Gynecologic Cancers

Joint Society Statement on Elective Surgery during COVID-19 Pandemic. Available at: aagl.org/news/covid-19-joint-statement-on-elective-surgeries

Recommendations for the surgical management of gynecological cancers during the COVID-19 pandemic -FRANCOGYN group for the CNGOF