key: cord-1030617-pjp9ad4c
authors: Zaorsky, Nicholas G.
title: Prostate and Pelvis on Pause Pending a Pandemic
date: 2020-10-01
journal: Int J Radiat Oncol Biol Phys
DOI: 10.1016/j.ijrobp.2020.07.013
sha: 3f8960eb88699742d74a7d72ca88d0922fccf7ab
doc_id: 1030617
cord_uid: pjp9ad4c

nan

Prostate and Pelvis on Pause Pending a Pandemic 1. Taking into consideration your hospital policies and regional COVID-19 considerations, would you have done anything differently in March 2020? 1 One could consider a longer duration of androgen deprivation therapy (eg, for 3-6 months).

a. What is your recommended fractionation for unfavorable intermediate risk patients?

I would most likely recommend ultrahypofractionation (eg, 7.25 Gy  5 fractions) or moderate hypofractionation (eg, 2.7 Gy  26 fractions), depending on baseline symptoms and patient preference. This is supported by the statement from the United States and United Kingdom ( Fig. 1 ) 2 and a recent meta-analysis. 3 2. How would you approach management of this patient after he represents with high-risk disease? a. Are you irradiating elective lymph nodes for highrisk cases during this time? What if the patient has baseline lymphopenia? (Both pelvic lymph node radiation therapy and baseline lymphopenia are predictors of radiation-induced lymphopenia per Schad MD, Adv Radiat Oncol, 2019, and lympho-penia is a maker for poor prognosis in COVID-19 patients).

The coverage of pelvic lymph nodes in an elective volume is controversial. For many patients, I treat 70.2 Gy to the high-risk volume and 46.8 Gy to pelvic nodal volume, all in 26 fractions using a stereotactic integrated boost. Several factors may dissuade one from elective radiation therapy (eg, history of lower pelvic surgeries or adhesions, unmanaged diabetes, or lymphopenia in the setting of COVID-19 risk).

b. Would you test this patient for SARS-CoV-2 infection? When and how often?

I would follow hospital/facility policy. Our hospital routinely asks anyone entering about symptoms (eg, temperature, fever, and cough) and takes a temperature. If there is concern, formal testing is performed. 

Delaying dilemmas: Coronavirus complications impacting the management of prostate cancer

Prostate cancer radiotherapy recommendations in response to COVID-19

Ultrahypofractionated versus hypofractionated and conventionally fractionated radiation therapy for localized prostate cancer: a systematic review and meta-analysis of phase III randomized trials