COVID-19: experts suggest updated treatment guidelines for bowel cancer

Written by Louis Gautier, Future Science Group

A panel made up of 15 experts has recently published updated recommendations for radiotherapy treatment for bowel cancer during the ongoing COVID-19 pandemic. Their guidance suggests higher doses for shorter periods to maximise social distancing whilst maintaining efficacy of treatment.

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An international panel of experts has recommended that a one week course of radiotherapy treatment for bowel cancer, followed by a delayed surgery, is the best course of action during the ongoing COVID-19 pandemic. The approach is designed to minimize the risk of patients coming into contact with the novel SARS-CoV-2 virus, while still giving patients the best chance of successful treatment.

The panel, led by David Sebag-Montefiore, Professor of Clinical Oncology at the University of Leeds (UK), comprises authors of leading studies investigating radiotherapy treatment for bowel cancer. Their recommendations were recently published in the journal Radiotherapy and Oncology, with a pre-proof available for short-term consideration.

“The COVID-19 pandemic is a global emergency and we needed to work very quickly to identify changes that would benefit patients. Our recommendations were published 20 days after our first meeting. This process normally takes many months, if not years,” explained Sebag-Montefiore.

The panel’s research suggests that surgery can be safely delayed by 12 weeks to reduce post-operative side effects, while maintaining the chances of successful treatment for bowel cancer. This allows surgeries to be scheduled after the peak of the COVID-19 pandemic has passed, reducing the risk of infection and easing the strain on healthcare systems.

The panel also suggests adjusting radiotherapy treatment pre-surgery to administer higher-intensity doses of radiation for a shorter period, rather than five weeks of radiotherapy and chemotherapy in combination. This follows a major UK-based study, which demonstrated the benefit of the one week course of radiotherapy for bowel cancer.

The shorter course of high dose radiotherapy treatment avoids the need for chemotherapy in bowel cancer, which is particularly crucial during the COVID-19 pandemic. Bowel cancer itself, as well as standard chemotherapy regimens cause severe immunosuppression, which makes patients much more susceptible to complications from COVID-19.Abandoning chemotherapy also means fewer hospital appointments for patients, allowing them to follow social distancing guidelines more closely making SARS-CoV-2 infection less likely still.

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Marijen C, Peters F, Rödel C et al. International expert consensus statement regarding radiotherapy treatment options for rectal cancer during the COVID 19 pandemic. Radiother. Oncol. doi: 10.1016/j.radonc.2020.03.039 (2020) (pre-proof);