Introduction/Background Chemoradiotherapy (CCRT) is the gold standard treatment for locally advanced cervical cancer. The COVID-19 pandemic resulted in a UK-wide lockdown in March 2020. As a ‘Category 1’ malignancy, cervical cancer remained a key treatment priority, but the safety of chemotherapy was unclear, and many centres including our institution required urgent implementation of spinal as opposed to general anaesthesia to facilitate brachytherapy. We evaluated the impact of COVID-19 on the CCRT pathway.
Methodology The central radiotherapy prescribing system at a single institution was interrogated to identify patients who commenced radical RT/CCRT from 1st April 2020 to 31st March 2021.
Results Primary RT/CCRT was delivered to 80 patients (adjuvant/salvage therapies were excluded). Median age was 53 years (range 30 – 77) and the majority had squamous cell carcinoma (75%). FIGO 2018 stage distribution was Stage I (3.8%), II (26.2%), III (47.5%) and IV (22.5%). Diagnostic imaging consisted of: MRI 96.3%; PET-CT 98.8%; both 95.0%. Concomitant cisplatin was administered to 81.3%; the remaining patients received neoadjuvant chemotherapy (10%) or had poor performance status/medical comorbidities precluding chemotherapy (8.7%). Median time to complete treatment was 39 days (range 31 – 59). Standard external beam dose of 4500cGy-5000cGy in 25 fractions was prescribed in virtually all cases (98.8%). Median brachytherapy dose was 2400cGy in 4 fractions. SABR boost was delivered to the cervix in 8.8% of cases (unfavourable anatomy or patient refusal). Spinal anaesthetic was performed for the majority of insertions. No patients tested positive for COVID-19 during RT/CCRT and/or required alteration to the usual treatment pathway following prior infection.
Conclusion Other than immediately adopting spinal anaesthesia for brachytherapy, the advent of a novel virus threat did not result in deviation to standard CCRT protocol. There was no effect on diagnostic imaging rates, dose-fractionation, concomitant cisplatin, or overall treatment times.
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