UPDATED STATEMENT MARCH 27
ABS RESPONSE TO COVID-19: statement on adjuvant vaginal and breast brachytherapy
Endometrial and breast cancer patients who meet the criteria for adjuvant brachytherapy should proceed with treatment without significant delays, as well as long as they are not displaying COVID-19 symptoms. In the current environment, we suggest endometrial patients are “consented” for delays up to 12 weeks, but recommend 9 weeks if possible as survival may be compromised. Reasons for considering this include 1) PPEs (personal protective equipment) might still be required 2) occasional delayed cuff healing for some patients 3) this treatment is considered elective by some 4) decreasing patient input during this pandemic may limit possible exposure to staff and other patients. Eliminating the vaginal cuff boost for higher risk patients undergoing external beam radiation maybe reasonable as level I data is lacking. For patients who have started vaginal brachytherapy, up to 14 days between fractions is also acceptable. Breast brachytherapy patients should also proceed with placement of the device and treatment in a timely fashion. For some low risk patients, such as DCIS where adjuvant BT may be considered elective, a mild delay of up to 2-3 weeks may be warranted in the current environment.
ABS RESPONSE TO COVID-19: The critical need to maintain brachytherapy services for our patients
In response to recent actions regarding the delay of elective surgical procedures amid the unprecedented demands that COVID-19 is putting on our medical system, the American Brachytherapy Society feels compelled to issue the following clarifications.
Brachytherapy procedures for cervical cancer patients should not be delayed under any circumstances for patients not displaying COVID-19 symptoms. In certain cases, it may be advisable for prostate cancer patients to delay brachytherapy treatment should they fall into established high-risk factors for COVID-19 and/or when treatment requires extended travel. In all cases, however, patients who have begun cancer treatment, including brachytherapy, and who are not displaying COVID-19 symptoms should complete their treatment. Delaying prostate brachytherapy may be appropriate for low and favorable intermediate risk patients. However, for higher risk patients undergoing a combination of external beam radiation and brachytherapy there should be no delay.