Table 1 Evidence-based recommendations for fractionated-adapted pandemic radiation oncology
Site | Criteria | Concept | Evidence/ Guideline |
|---|---|---|---|
Glioblastoma | KPS 100–80; age > 65/60 years | 2.67Gy/ 40.05 Gy + TMZ (MGMT methylated) | Perry et al., 2017 [33] |
KPS < 60 | 5.0 Gy / 25.0 Gy, no TMZ | Roa et al. JCO 2005 [34] | |
KPS < 50; age > 70 years | TMZ mono (MGMT methylated) or BSC | Malmström et al. 2012 Lancet Oncology [35] | |
All age groups, good performance status | Tumor treating field, especially if TMZ is postponed due to pandemic risk for severe pneumonia | Stupp et al. JAMA 2015 [36] | |
Brain metastases | 1–10 BM; good performance status | Stereotactic radiosurgery 1 × 18 Gy, or 1 × 20 Gy | Kocher et al. JCO 2011 [37] Yamamoto et al. Lancet Oncology 2017 [38] |
Postoperative | SRS of resection cavity e.g. 7 × 5 Gy or single fraction | Brown et al. Lancet Oncology 2017 [39] Mahajan et al. 2017 [40] Sahgal et al., 2017 [41] | |
Driver mutations | ALK: Targeted therapy first | various | |
Life expectancy > 3 months | 5 × 4 Gy Whole Brain Radiotherapy (WBRT) | Borgelt et al. RED Journal 1981 [42] | |
Poor performance status | Evaluate BSC with critical view of steroids | Mulvenna et al. Lancet 2016 [43] NCCN Guidelines | |
Meningeoma | WHO°1 | Watchful waiting or 5 × 5 Gy | NCCN Guidelines Alfredo et al. 2019 [44] |
WHO°2 | Watchful waiting after complete resection | NCCN Guidelines EANO Goldbunner et al. Lancet Oncology 2016 [45] RTOG 0539 Rogers et al. J Neurosurg 2018 [46] | |
Breast | DCIS | Omission of RT in low risk DCIS or Active surveillance + endocrine therapy or 15 × 2.67/ 40.05 Gy | Nilsson et al. Radiother Oncol 2015 [47] |
Invasive Breast cancer | Omission of RT in low risk carcinomas or 15 × 2.67Gy/ 40.05Gy or 5 × 5.2 /26Gy | Haviland et al. Lancet Onc. 2013 [48] | |
Including lymphatic drainage | 15 × 2.67Gy/ 40.05Gy | Haviland et al. Lancet Onc. 2013 [48] | |
Postmastectomy | Hypofractionation if no implant, 15 × 2.67Gy/40.05Gy or 15 × 2.9/43.5 Gy | Wang et al. 2019 [51] | |
Partial breast | ASTRO PBI criteria 38.5 Gy/ 10 fx BID 30 Gy/ 5 fx daily 28.5 Gy/ 5 fx once weekly 26Gy / 5 fx daily 20 Gy/ 1 fx IORT | Correa et al., 2017 [52] Livi et al. Eur J of Cancer 2015 [53] Brunt et al. FAST Forward Trial 2016 [49, 50] Vaidya et al. Lancet 2014 [54] Veronesi et al. Lancet Onc 2014 [55] | |
Lung | NSCLC Stage I | SBRT e.g. 3 × 15 Gy, 8 × 7.5 Gy, 1x34Gy [56] | Guckenberger et al. J Thoracic Onc 2013 [57] |
NSCLC stage III | 24 × 2.75 Gy | ||
SCLC limited disease | 15 × 2.67Gy / 40.05 Gy | ||
Prostate | Low risk | Postpone Therapy perhaps with ADT, active surveillance or hormonotal deprivation | NCCN Guidelines |
Active Surveillance | Â | Hamdy et al. & Donovan et al. NEJM 2016 ProtecT [60] | |
Watchful waiting | Life expectancy < 10 years, T1–4, GS ≤7 | NCCN Guidelines | |
Intermediate Risk or high Risk | neoadjuvant ADT 2–3 months | DART01/05 GICOR Zapatero et al. Lancet Oncol 2015 [61] EORTC 22991 Bolla et al. JCO 2016 [62] | |
20x 3Gy / 60Gy | |||
age < 75 years: 42.7 Gy/ 7 Fx every other day | HYPO-RT-PC, Widmark et al., [65] | ||
Adjuvant/ Salvage Situation | Watchful waiting or ADT | NCCN Guidelines | |
|  | 52.5 Gy / 20 fx | Chin et al. RED Journal 2020 | |
Lymphatic drainage RT | Evaluate critically, only if visible nodal disease | GETUG-01-Trial Pommier et al., J Clin Oncol 2007 and IJROBP 2016 Supiot et al. 2013 [66,67,68] | |
Palliative setting | Bone metastases | 8 or 10 Gy/ 1 fx 20 Gy/ 5 fx 21 Gy/ 3 fx | Chow et al. JCO 2007 [69] |
Head & neck | QUADshot: 3.5 Gy BID × 2 days, repeated Q4 weeks interval ×  2 times | Spanos et al. Int J Radiat Oncol Biol Phys. 1989 [70] | |
Bleeding | 8 Gy / 1 fx | Sapienza et al. Clinical and Translational Radiation Oncology 2019 [71] | |
Oligometastatic | SBRT, e.g. 1–5 fractions | Otake et al. Cancers 2019 [72] |