Latest Developments for the Management of Rectal Cancer Patients during COVID-19

The Treatment Recommendations for Colorectal Cancer Patients in the Pandemic

1. The Rationale for the Newer Guidelines

The patients of the rectal cancer are already on the thinner side of the immunity, therefore, deliberately risking their lives, and “presenting” them to COVID-19 is never desirable.

The previously developed protocols for the “non-pandemic” period can’t be observed as it is. A benefit to risk ratio-dependent more current guidelines is the need of the time.

2. Latest Guidelines for the Management of the Rectal Cancer

The journal “Radiotherapy and Oncology” recently published a consensus statement by leading cancer experts for the treatment of rectal cancer. 

They recommend a modification in the radiotherapy regime. 

It suggests the administration of one week of high-radiation therapy instead of five-week radiotherapy before surgery.

Following this protocol, chemotherapy can be avoided. Avoidance of chemotherapy is the requirement in this situation as it can further reduce the patient’s immune status. 

Surgery can be delayed further for 12 weeks safely. The Previous protocol was to perform surgery 1 or 2 weeks after the radiation.

3. The Base of the Guidelines- The Short Course Radiotherapy (SCRT)

The authorities used the previously available guidelines of the “European Society for Medical Oncology” (ESMO) as the base. 

They improvised with the latest research available about “Preoperative short-course radiotherapy (SCRT)” by David Sebag-Montefiore, Professor of Clinical Oncology and Honorary Clinical Oncologist with the Leeds Teaching Hospitals NHS Trust.

According to this study, 3469 patients underwent SCRT for rectal cancer but the time of the surgery following the radiation was split into 3 groups.

1. 76% – surgery after 0-7 days
2. 19% -surgery after 8-14 days
3. 5%- surgery after 15-27 days

This study concluded that there was no difference in postoperative outcomes up to a year due to the time interval between SCRT and surgery.¹

This data became the central argument presented in the support of the latest guidelines of deferring surgery with short-course radiation therapy.

4. The Goods of the Newer Guidelines in the COVID-19 Pandemic

Experts have developed these recommendations taking into account the current requirements. The advantages are;

• Fewer hospital visits due to shorter radiotherapy mean less likelihood of encountering the COVID-19 virus.
• Elimination of Chemotherapy which could have further dropped the immune status of these patients
• Delaying of Surgery- As the hospitals are coping with an overwhelming surge of COVID-19 patients, delaying the elective surgeries is the ongoing practice

The global emergency of the COVID-19 is re-shaping the medical practices rapidly. The “Pandemic-led” protocols developed in a few weeks will provide enormous advantages to the rectal cancer patients as well as hospitals.

Reference

1. 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. Clin Oncol (R Coll Radiol). 2020;32(2):e46-e52. doi:10.1016/j.clon.2019.08.008