Steadfast.

Top Line: Remember, brachytherapy for higher-risk cancers is not an elective procedure.

The Study: Here we have data-informed recs from US experts on how to prioritize and time brachytherapy treatments during the COVID-19 pandemic. The first important question is whether a patient requires immediate treatment. For early-stage favorable breast, uterine, and prostate cancers—as discussed previously in respective site-specific guidelines—delaying treatment start with endocrine therapies for 3-6 months is likely the best route. For other gynecologic and prostate cancers, timely treatment remains paramount. Fortunately there are other strategies for risk mitigation. That includes, of course, shorter fractionation schemes, as summarized in Table 1, with no more than 2-3 treatments being required in any scenario. Next should come consideration of eliminating, or at the very least consolidating, any OR time. This can be achieved with alternative analgesia to avoid intubations (e.g., neuraxial or local analgesia, pudendal nerve blocks, moderate sedation, etc). Furthermore, staff should be kept at a bare minimum, with anesthesia teams only in the room during critical components of their care.

TBL: While every attempt, including referral to another facility if necessary, should be made to avoid delay in brachytherapy for high-risk gyn and prostate cancers, there are other strategies to employ to minimize exposure risk while maintaining oncologic outcomes. | Williams, Brachytherapy 2020