Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
Mitigating the spread of COVID-19 is of utmost priority now that containment measures have failed. Social distancing will help "flatten the curve" of new cases so as to prevent catastrophic failure of health care delivery systems that are overwhelmed by new serious cases of pneumonia. Radiation oncology services should do their part to triage patients where timely care is not absolutely necessary so as to prevent further transmission to a very vulnerable population.
Answer from: Radiation Oncologist at Community Practice
Lets break it down by risk group:
Very low/low risk: Should be put on active surveillance and return in 6 months for a PSA.
Favorable intermediate risk: Should be put on active surveillance for the current time and return in 3-6 months for a repeat PSA. Very good data that early on active surveill...
Comments
Radiation Oncologist at Radiation Oncology Associates
Thoughts on high risk delaying XRT for 7-8 m in pa...
Thoughts on high risk delaying XRT for 7-8 m in pa...
Answer from: Radiation Oncologist at Academic Institution
I agree with my colleague, @Hiram A. Gay. I would add that many patients for whom ADT is not necessary can be convinced to a more appropriate Active Surveillance strategy and avoid or delay ADT and XRT altogether. High risk patients can safely be treated with a longer interval of 'neoadjuvant' ADT b...
Answer from: Radiation Oncologist at Academic Institution
I agree with my colleagues above. Our hypofractionation regimen is 7020 cGy/26 fractions to the prostate and prox SVs and 5200 cGy/26 fractions to the distal SVs and lymph nodes. As @Eddie Zhang referenced above, the 10 year results from our phase III clinical trial were just published in the J...
Answer from: Radiation Oncologist at Community Practice
Don't forget prostate SBRT in 5 fractions, every other day.
A commonly employed regimen is 8 Gy to prostate and 5 Gy to SV. Some series have even given 5 Gy to nodes for high risk patients. There have been thousands of patients treated with prostate SBRT now with excellent PSA control and low singl...
Answer from: Radiation Oncologist at Community Practice
Yes, at the Lynn Cancer Institute we have delayed all non-essential starts and follow ups, including prostate and breast patients that are on hormonal therapy.
Answer from: Radiation Oncologist at Community Practice
As per FAQ’s posted by ASTRO:
New patient consults and new patient starts may be triaged on a case-by-case basis according to the urgency of the situation following discussion with the multidisciplinary care team. Examples of non-urgent cases that may be delayed for up to two months include p...
Answer from: Radiation Oncologist at Academic Institution
Yes.
Answer from: Radiation Oncologist at Academic Institution
This is all very important what has been discussed so far about prostate cancer, but how about addressing the original question of this post "stopping new starts of patients who can be triaged for 2-3 months LIKE prostate cancers on ADT" (=but NOT prostate cancers, but other cancers)? I need your in...
Comments
Radiation Oncologist at Case Western Reserve University/ University Hospitals Seidman Cancer Center
@Gabor Altdorfer: Canceling surgery is simi...
@Gabor Altdorfer: Canceling surgery is simi...
I think that prostate cancer patients that already...
Are there any hypofractionation regimens that you ...
I personally use 70 Gy in 28 fractions to the pros...
I like the idea of the hypo sib. @Thomas P. Kole, ...
@Bryan Goss 10 year results of Fox Chase hypofrac...
Thanks!
@Eddie Zhang, the Fox Chase group used 70.2 Gy in ...