Non-Melanoma Skin Cancer and COVID-19: Modifications to Current Radiotherapy
Posted: Tuesday, June 30, 2020
Management of patients with non-melanoma skin cancer is being adjusted to reduce patient exposure to COVID-19. Measures have been implemented to defer radiation therapy when possible or to adhere to National Institute for Health and Care Excellence (NICE) guidelines. “Individual treatment centers should follow the recently published ‘COVID-19 Rapid Guideline: Delivery of Radiotherapy’ and adapt their strategy based upon staffing, capacity, and structure,” advised J.P. Nobes, MBBS, FRCR, of Norfolk and Norwich University Hospital, United Kingdom, and colleagues in an editorial in Clinical Oncology.
The authors recommended that radiotherapy for patients with definitive or postoperative basal cell carcinoma should be stopped during the COVID-19 pandemic. Patients with priority level 1 through 3 cutaneous squamous cell carcinoma, Merkel cell carcinoma, or rare skin pathologies should have their radiotherapy adjusted to modified fractionation. However, if the cancer was incompletely removed, treatment for these patients should be deferred for 2 to 3 months. In addition, postoperative therapy for immunocompromised patients should be administered only when the benefits outweigh the risks, given the increased susceptibility to contracting COVID-19. To prevent increased patient exposure, the investigators suggested implementing hypofractionated radiotherapy regimens in less frequent, but equally efficient schedules.
Regarding palliative treatment, Dr. Nobes and colleagues recommended continuation of treatment only when beneficial for patients. These assessments should be considered based on the patient’s condition, as the priority level is variable and determines the recommended course of action. For example, palliative radiotherapy and metastatic spinal cord compression are priority level 4 and 2, respectively. Moreover, pharmacologic intervention may need to be delayed in patients with metastatic or recurrent non-melanoma skin cancer.
Disclosure: The authors reported no conflicts of interest.