Radiation for rectal cancer under COVID-19: consensus statement offers guidance

Takeaway

• An international expert consensus statement outlines treatment options for rectal cancer in the context of COVID-19.

Why this matters

• COVID-19 presents special challenges for rectal cancer treatment.

Key points

• In early rectal cancer, total mesorectal incision (TME) is strongly recommended, without preoperative radiotherapy.
• In intermediate-stage cancer, TME alone is strongly recommended in countries with high-quality surgery.
  • Clinicians should discuss radiotherapy use in the COVID-19 setting, as it is likely to have small benefit.
  • When used, short course radiotherapy (SCRT) is preferred over chemoradiotherapy (CRT).
• In locally advanced cases, SCRT is strongly recommended over CRT because of similar survival outcomes in phase 3 trials and reduced social exposure.
• A delay between SCRT and surgery may provide a benefit in clinical practice and in the COVID-19 setting.
• In advanced-stage disease, there are 2 options:
  • Preoperative CRT with long-course radiotherapy, which is the most established treatment, with capecitabine chemotherapy limited to 5-5.5 weeks.
  • SCRT with or without neoadjuvant chemotherapy, which involves a shorter radiotherapy that can provide benefits compared with CRT.
  • Both options are acceptable, but SCRT with delay is strongly recommended in patients who are elderly, who have poorer performance status, or who are unfit for chemotherapy or standard CRT.