Table 2. Summary of the proposed changes in radiotherapy management for various tumors.
| Cancer site | RT schedule | Postpone RT start | Interrupt RT* |
|---|---|---|---|
| NSCLC | SBRT: no changes Consider hypofractionation for stage III without concomitant chemotherapy Adjuvant treatment not recommended | No Consider postponing SBRT in indolent tumors | Yes |
| SCLC | Limited disease: no changes Extensive disease: may consider PCI and thorax consolidation if response | No | Yes |
| Breast | Keep 15 fractions Consider 5 fractions (26 Gy/5 fractions) for selected patients (>60 years, breast only RT) Consider omission of RT for low risk elderly (>70 years) patients | Yes, up to 16 weeks | Yes |
| Uterine cervix | No changes | No | No |
| Endometrium | Stage I, G2-G3 intermediate risk or Stage II, and stage III: consider no RT according to comorbidities | Yes | Yes |
| Vulva & Vagina | No changes | No | Yes, if RT adjuvant |
| Head & Neck | No changes | No | No |
| CNS | No changes Hypofractionation for glioblastoma (research protocol) | Yes, low grade | |
| Prostate | No changes Favor hypofractionation | Yes | Yes |
| Bladder & Testis | No changes Consider hypofractionation for bladder | No | No |
| Esophagus | No changes | Yes, up to 3 months in indolent disease | Individualize |
| Stomach | No neoadjuvant or adjuvant RT | Yes, up to 3 months | Individualize |
| Pancreas | Consider neoadjuvant SBRT (research protocol) No neoadjuvant or adjuvant RT (Neoadjuvant CT maintained) | No | Individualize |
| Rectum | No changes or consider neoadjuvant RT in 5 x 5 Gy (ECOG 0-2) followed by CT in the interval between RT and surgery | No | Individualize |
| Anal canal | No changes | No | Individualize |
| Pediatrics | No changes | No | Individualize |
| Cranial Radiosurgery | No changes | Yes, only benign diseases | No |
| SBRT not for lung cancer | No changes | No | No |
*
Radiotherapy interruption should be considered if the patient is a suspected or confirmed case of COVID-19 or according to clinical conditions if the treatment is to proceed. If interruption was indicated, the recommendation was for 15 days of interruption and then to restart with a dose compensation if applicable. The impact of treatment gaps and dose compensation should be evaluated according to Gay et al. 2019 (15).
Legend: RT = radiotherapy; NSCLC = non-small cell lung cancer; SCLC = small cell lung cancer; CNS= central nervous system; SBRT = stereotactic body radiotherapy; RT = radiotherapy; CT = chemotherapy; ECOG = Eastern Cooperative Oncology Group performance status.