Adjuvant Radiation and Chemoradiation
- All patients for which there are standard indications
for postoperative radiation alone should proceed with treatment as per
normal, without intentional delay.
- Guidance for the use of Chemoradiation
- Tier 1 – Patients over 70 years of age were underrepresented in the
trials supporting the use of chemoradiotherapy. There is some evidence
from meta-analyses that the addition of chemotherapy to radiation for
patients over the age of 70 may confer minimal benefit or may even be
detrimental.16 Therefore, it is strongly encouraged
that during the COVID19 pandemic, medical oncologists consider the
omission of chemotherapy from the adjuvant treatment regimens for
patients over 70.
- Tier 2 – For pathological findings of microscopic extranodal
extension (ENE) (< 1mm ENE) in patients with p16 + cancer
there is retrospective evidence to support omitting chemotherapy
without compromising oncologic outcomes. It is therefore reasonable to
consider omitting chemotherapy with radiation during the COVID 19
pandemic.17,18
- Tier 3 – In the following cases the recommendation is to proceed with
chemoradiation with the caveat that there should be shared informed
decision making between the clinician and the patient of the risks
versus the benefits of adding cytotoxic chemotherapy to the treatment
regimen during the COVID19 pandemic.
- All p16- cancers with positive margins or any amount of ENE.
- All p16 + cancers with positive margins or macroscopic
(>1mm) ENE.