Table 4.

Systematic approach to decision making

Goals of treatment	Types of treatment	Examples of treatment	Decision making for radiation therapy
Curative	Radical	Head and neck cancer, cervical cancer	∗
	Adjuvant	Breast cancer, sarcoma, head and neck cancer, moderate- and high-risk prostate cancer, endometrial cancer	†
	Neoadjuvant	Rectal cancer, sarcoma	†
Palliative	Emergency	Cord compression, superior vena cava obstruction, life-threatening bleeding	∗
	Pain control	Bone metastasis, multiple brain metastasis	‡

Note: Stereotactic ablative body radiation or stereotactic radiosurgery for brain lesions is not available in Iran.

^∗Do not defer treatment unless a reasonable alternative exists (eg, start hormone therapy for intermediate- and high-risk prostate cancer and defer radiation treatment for a couple of weeks). If decision is made to start radiation therapy (eg, nasopharyngeal cancer), extensive education on hand hygiene and physical distancing is given directly by the radiation oncologist. All patients have access to hotline to ask questions and report symptoms. Whenever possible, hypofractionated regimen is used.

^†Categorize evidence behind the indication of radiation therapy and absolute benefit of the treatment. Categorize if there is survival benefit from radiation therapy versus local control benefit (eg, boost in breast radiation therapy can be omitted). Assess whether alternative exists to defer or replace radiation therapy. Prioritize by age and other comorbidities of the patient. Radiation treatment can be deferred for some time (eg, radiation treatment might be canceled for elderly patients with early stage breast cancer). Some cases will be deferred or cancelled in this category.

^‡Defer the treatment and try to use alternative options, such as medical treatment for pain control or use steroidal drugs for multiple brain metastasis.