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Gynecologic radiation therapy in low and middle income countries during the COVID-19 pandemic
  1. Rohini K Bhatia1,
  2. Katie E Lichter2,
  3. Lavanya Gurram3,
  4. Emily MacDuffie4,
  5. Dorothy Lombe5,
  6. Gustavo R Sarria6 and
  7. Surbhi Grover7,8
  1. 1 Department of Radiation Oncology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
  3. 3 Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
  4. 4 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5 Oncology, Cancer Diseases Hospital, Lusaka, Zambia
  6. 6 Department of Radiation Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
  7. 7 Department of Radiation Oncology, Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA
  8. 8 University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Surbhi Grover, Department of Radiation Oncology, Botswana-University of Pennsylvania Partnership, 3400 Civic Center Blvd. Philadelphia, PA 19104, Pennsylvania, USA; surbhigrover{at}


The COVID-19 pandemic has forever affected healthcare and posed an incredible challenge to our society to care for our sick. Patients with cancer were found early on to have higher rates of complications with COVID-19. Radiation therapy is an integral part of treatment for many types of gynecologic cancer and adaptation on its utilization during the pandemic varied across the globe. In this review, we detail certain guidelines for the use of radiation in gynecologic cancers during the pandemic as well as real world accounts of how different countries adapted to these guidelines or created their own based on individualized resources, staffing, government restrictions, and societal norms. Critically, this review demonstrates the breadth of fractionation schemes and technologies used when resources were limited but highlights the importance of long term follow-up for many of our patients during this time.

  • brachytherapy
  • COVID-19
  • radiation oncology

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  • Contributors RB, KEL, and SG conceived of the presented idea. RB, KEL, LG, DL, EM, GS, and SG contributed to reviewing papers, researching concepts, and writing the manuscript. All authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.