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Consensus
Medwave 2020;20(8):e8012 doi: 10.5867/medwave.2020.08.8012
Reducing the impact of COVID-19 on radiation oncology units of developing countries: A rapid review and expert consensus
Nadia Montero-Oleas, Raúl Puente-Vallejo, Bárbara León-Micheli, Andrés Imbaquingo-Cabrera, Mónica Silva, Elizabeth Gamarra, Byron Álvarez-Rodas, Nelson Segovia, Pablo Aldaz-Roldan, Cristina Nuñez-Silva, Karina Zurita-Vivero, Alex Carrión, José Molina-Jaramillo, Andrés Rodríguez-Balarezo, Yuri Betancourt, Luis De Los Reyes
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Key Words: radiotherapy, COVID-19, coronavirus, hypofractionated, pandemic, cancer

Abstract

Objective
To generate recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources.

Methods
We did a rapid review of the literature, searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified Delphi method, the consensus was reached among 14 certificated radio-oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed.

Results
A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection. Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible.

Conclusions
We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.


 

No English version is available for this article.

Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Objetivo
Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados.

Métodos
A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento.

Resultados
Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible.

Conclusión
Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19.

Authors: Nadia Montero-Oleas[1], Raúl Puente-Vallejo[2], Bárbara León-Micheli[3], Andrés Imbaquingo-Cabrera[2], Mónica Silva[4], Elizabeth Gamarra[5], Byron Álvarez-Rodas[6], Nelson Segovia[3], Pablo Aldaz-Roldan[7], Cristina Nuñez-Silva[2], Karina Zurita-Vivero[2], Alex Carrión[2], José Molina-Jaramillo[6], Andrés Rodríguez-Balarezo[8], Yuri Betancourt[1], Luis De Los Reyes[2]

Affiliation:
[1] Posgrado de Radioterapia, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
[2] Departamento de Radioterapia, Hospital Oncológico SOLCA Núcleo de Quito, Quito, Ecuador
[3] Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
[4] Servicio de Radioterapia, SOLCA Manabí, Núcleo Portoviejo, Portoviejo, Ecuador
[5] Departamento de Radio-Oncología, Instituto Oncológico Nacional Dr. Juan Tanca Marengo, SOLCA-Guayaquil, Guayaquil, Ecuador
[6] Unidad Académica de Salud y Bienestar, Universidad Católica de Cuenca, Cuenca, Ecuador
[7] Escuela de Medicina, Departamento de Ciencias de la Salud, Universidad Técnica Particular de Loja, Loja, Ecuador
[8] Unidad de Radioterapia, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador

E-mail: nadiamonteromd@gmail.com

Author address:
[1] José Félix Barreiro E15-242
Quito, Ecuador
Código postal: 170209 San Isidro del Inca

Citation: Montero-Oleas N, Puente-Vallejo R, León-Micheli B, Imbaquingo-Cabrera A, Silva M, Gamarra E, et al. Reducing the impact of COVID-19 on radiation oncology units of developing countries: A rapid review and expert consensus. Medwave 2020;20(8):e8012 doi: 10.5867/medwave.2020.08.8012

Submission date: 25/5/2020

Acceptance date: 11/8/2020

Publication date: 7/9/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by three reviewers, double-blind

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