Experts Issue Recommendations for Patients with Rectal Cancer During the COVID-19 Pandemic

Leading cancer experts from across Europe issued an international expert consensus statement in the journal Radiotherapy & Oncology regarding radiotherapy treatment options for patients with rectal cancer during the coronavirus disease 2019 (COVID-19) pandemic.¹

The researchers used the European Society for Medical Oncology (ESMO) rectal cancer guidelines as a framework for crafting their recommendations. Based on the latest research evidence, the experts suggested a one-week course of radiotherapy and delaying surgery as the most effective way to treat patients with rectal cancer during the pandemic. 

“The COVID-19 pandemic is a global emergency and we needed to work very quickly to identify changes that would benefit patients. Our recommendations were published 20 days after our first meeting,” leader of the expert panel, David Sebag-Montefiore, professor of clinical oncology at the University of Leeds and honorary clinical oncologist with the Leeds Teaching Hospitals NHS Trust, said in a press release.² “This process normally takes many months, if not years.”

The short course of treatment involves higher-intensity radiation, rather than the usual 5 weeks of radiotherapy coupled with chemotherapy. Moreover, the experts indicated that surgery, which generally happens 1 to 2 weeks after radiotherapy, can be safely postponed by up to 12 weeks.

Shorter-course radiotherapy avoids the need for chemotherapy, which would further suppress the immune system. Moreover, it also reduces the number of hospital visits, which allows patients to maintain social distancing guidelines. 

According to the researchers, an organ preservation approach may also be considered during the COVID-19 pandemic, providing that resources for an adequate surveillance including imaging and endoscopy are available to detect local failures that require salvage surgery. 

Given that individuals with rectal cancer are more susceptible to severe complications from the virus due to their weakened immune system, these recommendations pose the best chance of successfully treating the disease while at the same time reducing the side effects of treatment and risks of COVID-19 infection, according to the researchers.

“Our guidelines will result in a very substantial change in treatment across the globe,” said Sebag-Montefiore. “During the covid-19 pandemic, our patients will benefit from the use of an effective, shorter and safer radiotherapy treatment.” 

These recommendations follow the publication of a study which demonstrated the benefit of the one-week course of radiotherapy. This study suggested that the time interval between pre-operative short-course radiotherapy (SCRT) and surgery does not influence postoperative outcomes up to a year after surgery.³

In the study cohort of 3,469 patients with surgically treated rectal cancer who received SCRT in the English National Health Service between April 2009 and December 2014, the time to surgery was 0-7 days for 76% of patients, 8-14 days for 19% of patients, and 15-27 days for 5% of patients. Though there was a clear variation in relation to different patient characteristics, there was no evidence of differences in postoperative outcomes in relation to interval length.

References:

1. University of Leeds. Treating bowel cancer during the covid-19 epidemic. University of Leeds website. Published April 6, 2020. leeds.ac.uk/news/article/4572/treating_bowel_cancer_during_the_covid-19_epidemic. Accessed April 8, 2020.

2. Marijnen CAM, Peters FP, Rödel C, et al. International expert consensus statement regarding radiotherapy treatment options for rectal cancer during the COVID 19 pandemic. Radiotherapy & Oncology. doi:10.1016/j.radonc.2020.03.039.

3. Levick BA, Gilbert AJ, Spencer KL, et al. Time to Surgery Following Short-Course Radiotherapy in Rectal Cancer and its Impact on Postoperative Outcomes. A Population-Based Study Across the English National Health Service, 2009-2014. Clinical Oncology. doi:10.1016/j.clon.2019.08.008.