Romesser Paul B, Wu Abraham J, Cercek Andrea, Smith J Joshua, Weiser Martin, Saltz Leonard, Garcia-Aguilar Julio, Crane Christopher H
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Medicine, Early Drug Development Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Adv Radiat Oncol. 2020 Apr 22;5(4):687-689. doi: 10.1016/j.adro.2020.04.011. eCollection 2020 Jul-Aug.
The COVID-19 pandemic will consume significant health care resources. Given the concerns for rapidly increasing infection rates in the United States, impending staffing shortages, and the potential for resource reallocation, we rapidly reevaluated our rectal cancer practice policies during this public health emergency. Before the pandemic, we commonly used total neoadjuvant therapy with a strong preference for long-course chemoradiation. In the setting of the ongoing pandemic, we now mandate short-course radiation therapy (SCRT). Despite multiple randomized trials demonstrating no difference in locoregional recurrence, distant recurrence, or overall survival between SCRT and long-course chemoradiation, the adaptation of SCRT in the United States has been low given concerns for less tumor downstaging and increased toxicity. In the setting of the ongoing and likely prolonged COVID-19 pandemic, we feel that these concerns must be reevaluated, because SCRT presents a well-validated alternative that will allow us to meet the needs of a greater number of potentially curable patients at a time when resources are severely and acutely constrained.
新冠疫情将消耗大量医疗资源。鉴于对美国感染率迅速上升、即将出现的人员短缺以及资源重新分配可能性的担忧，我们在此次公共卫生紧急事件期间迅速重新评估了我们的直肠癌诊疗政策。在疫情之前，我们通常采用全新辅助治疗，强烈倾向于长程放化疗。在当前疫情背景下，我们现在规定采用短程放疗（SCRT）。尽管多项随机试验表明，短程放疗与长程放化疗在局部区域复发、远处复发或总生存率方面并无差异，但由于担心肿瘤降期效果较差和毒性增加，短程放疗在美国的应用率一直较低。在当前以及可能持续较长时间的新冠疫情背景下，我们认为必须重新评估这些担忧，因为短程放疗是一种经过充分验证的替代方案，在资源严重且迫切受限的情况下，它将使我们能够满足更多潜在可治愈患者的需求。
