Table 1.

Priority levels by disease site

Disease-specific priority scales (COVID-negative patients)	Level 1 (continue radiation)	Level 2 (short delay of radiation if needed)	Level 3 (consider holding radiation)
Breast (see Appendix E1 for more detailed breast guidelines)	Nonmetastatic inflammatory breast cancer Locoregional disease progressing through chemotherapy	All other breast cancer not meeting levels 1 and 3	Patients meeting CALBG/PRIME II criteria for omission of radiation therapy ER+ DCIS for patients meeting criteria from RTOG 9804, particularly if they can take hormone therapy
Central nervous system	High-grade gliomas of brain and spine tumors Benign or other tumors causing or with immediate threat of progressive neurologic symptoms	Symptomatic low-grade glioma Cases where chemotherapy may permit delay of radiation	Asymptomatic meningioma, pituitary adenoma, craniopharyngioma, pilocytic astrocytoma Asymptomatic low-grade glioma after gross total resection Trigeminal neuralgia Schwannomas
Gastrointestinal	Curative-intent anal, esophageal, and gallbladder/bile duct cancers Curative-intent rectal cancer that is medically inoperable	Neoadjuvant/adjuvant pancreas and rectal cancer treatment courses	None
Genitourinary	Curative-intent bladder cancers High-grade prostate cancer not able to receive androgen deprivation Genitourinary small cell carcinoma treated with curative intent Patients in middle of combined brachytherapy and external beam radiation therapy	All other curative-intent prostate cancers Any cases of prostate cancer on androgen deprivation or low-risk prostate cancer cases that have not yet started radiation therapy can be triaged to the bottom of the level 2 patients	None
Gynecologic	Cervical cancer with severe bleeding Locally advanced vulvar or vaginal cancer causing severe pain	Postoperative vulvar cancer Inoperable endometrial cancer Postoperative cervical cancer (can be delayed up to 8 wk postoperatively) After induction chemotherapy, postoperative endometrial cancer (4-wk break allowed after chemotherapy)	Postoperative cases of endometrial cancer to be scheduled for induction chemotherapy or requiring vaginal brachytherapy alone (up to 4-8 wk postoperatively)
Head/neck	All curative cases where treatment with radiation therapy or concurrent chemoradiation is indicated High-risk postoperative cases based on pathologic and intraoperative findings including recurrent well-differentiated extrathyroidal carcinomas	All curative cases where induction chemotherapy is deemed clinically appropriate Intermediate-risk postoperative cases Low-grade unresectable salivary gland malignancies Recurrent parotid/skull base pleomorphic adenoma Medium to large COMS choroidal melanoma or symptomatic choroidal melanoma regardless of COMS criteria Symptomatic or secretory paragangliomas Symptomatic cutaneous nonpigmented carcinomas or high-risk postop cutaneous nonpigmented carcinomas	Keloids Small COMS choridal melanoma Asymptomatic glomus tumors Slow-growing small basal cell carcinoma with mild or no symptoms, in a patient age >70 y Asymptomatic cutaneous nonpigmented carcinomas located in low-risk anatomic regions
Lymphoma	Patients with high-grade lymphomas with severe or life-threatening symptoms	Consolidation therapy for high-grade lymphomas Most patients with low-grade lymphomas	Remaining patients with low-grade lymphomas, to be assessed individually
Palliative	Cord compression from histology other than chemotherapy-naïve small cell lung cancer or lymphoma and not amenable to surgical decompression Symptomatic brain metastases not amenable to surgical decompression or brain metastases >5 mm from histologies not anticipated to respond to systemic therapy Malignant airway obstruction not amenable to surgical intervention/stenting. SVC syndrome not amenable to thrombectomy/stenting Acute hemorrhage from primary or metastatic disease not amenable to embolization/other direct intervention Severe pain from primary or metastatic disease not responding to conservative measures Heterotopic bone (at discretion of doctor)	Painful spine metastasis without epidural extension or other immediate risk to the neuraxis Spinal cord compression or spine metastases with epidural disease in patient with chemotherapy-naïve small cell lung cancer or lymphoma who can receive chemotherapy Brain metastases <5 mm anticipated to be responsive to targeted agents or immunotherapy Other metastatic sites causing non–life-threatening symptoms, particularly those that may respond to conservative measures (eg, pain, shortness of breath stable on room air) Patients with stable or minimally symptomatic oligometastatic disease
Pediatrics	All curable cases where delay of radiation is not possible	All cases where chemotherapy or other interventions can be safely used to delay initiation of radiation therapy	All elective or nonessential radiation cases
Sarcoma	Palliation of extreme pain or uncontrolled bleeding	All other neoadjuvant, adjuvant, and definitive cases	None
Thoracic	Limited-stage small cell lung cancer All patients with nonmetastatic node-positive or rapidly proliferating node-negative thoracic tumors for which the (time-sensitive) goal is cure and where alternative management is not possible	Consolidation of oligometastatic and oligoprogressive lung cancer Stage I NSCLC Postoperative thoracic tumors without residual disease Pulmonary ground glass opacities without solid component	None

Abbreviations: CALGB = Cancer and Leukemia Group B; COMS = Collaborative Ocular Melanoma Study; ER+ = estrogen receptor positive; NSCLC = non small cell lung cancer; RTOG = Radiation Therapy Oncology Group; SVC = superior vena cava.