Table 2.

Radiotherapy Treatments that may be omitted.

Disease Site	Subsite or classification	Modality	Comments and Evidence
Breast
	Breast Conservation
	DCIS	Omission of radiotherapy to whole breast [27]	No survival benefit, small benefit in loco-regional recurrence
	Invasive disease Low risk, older patients	Omission of radiotherapy to whole breast [29], [47]	Endocrine therapy only sufficient in > 70 (>65in PRIMEII) [29]
	Invasive disease Genomic profile low risk	Omission of radiotherapy to whole breast	LUMINA, IDEA, PRECISION, PRIMETIME trials ongoing (caution outside of trial)
	Age ≥ 50, ER+, Her2- breast ca without other adverse pathologic features	Omission of boost radiotherapy [26], [48]	No survival benefit
	Post Mastectomy
	T1-2 N1 (Node + Breast Cancer)	Omit radiotherapy	NSABP B-51/RTOG 1304 trials ongoing
CNS
	Glioblastoma Age > 60, methylated	Temozolamide only [49], [50]	Standard radiotherapy associated with poor outcomes
	Low grade glioma	Omit radiotherapy
	Asymptomatic meningioma Gr 1–2	Omit radiotherapy
	Asymptomatic AVM	Omit radiotherapy
Esophagus
		Resection or chemoradiation rather than trimodality therapy
Gastric
	Resectable	Treat with chemotherapy only
	Unresectable	Treat with chemotherapy only [51]
Lung
	SCLC, Extensive	Omit prophylactic cranial irradiation [52]	Also consider omission of consolidation thoracic radiotherapy in extensive stage disease
Pancreas
	Unresectable	Omit radiotherapy [53]	Consider chemotherapy or clinical trial
Prostate
	Low, favorable intermediate risk	Active surveillance [54]
Benign Disease
	Keloid, Heterotopic Ossification, Actinic Keratosis	Omit radiotherapy	Not life-threatening, topicals (NSAIDS) may be reasonable alternatives (vs. delay in the far future)
Palliative
	Painful mets, uncomplicated, other systemic options		Ensure medical optimization (e.g. WHO Pain Ladder)
	Oligometastatic (e.g. Prostate Cancer)	Omit radiotherapy	Systemic treatment e.g. androgen deprivation therapy
	Postoperative radiotherapy (for pathologic fracture) [55]	Omit radiotherapy	Limited/evidence of benefit
	CNS mets from NSCLC needing WBRT [19]	Omit radiotherapy	Best supportive care including steroids
Testicular
	Seminoma, stage I	Omit radiotherapy	Consider observation or carboplatin

These therapies have (mainly) been established by randomised controlled evidence and have are frequently considered a standard of care. In the context of a pandemic the risk benefit of these treatments is altered. General criteria for omission may include more time-sensitive need for treatment decision-making (go vs. no go) and availability of non-emergency/urgency, lower-risk alternatives, etc. that make the additional risk of treating the patient during the pandemic greater than the risk of omitting radiation taking alternatives into account.