Public health measures, radiotherapy, and the novel coronavirus outbreak

In health practice, the quarantine refers to the separation of persons or communities who are exposed to an infectious disease. Isolation, in contrast, applies to the “separation” of persons who are known to be infected.
Of importance is that isolation and quarantine can be voluntary or imposed by law. However, these classical public health measures are usually of limited utility for highly transmissible diseases. Other tools that the public health has at hand are social distancing and community containment. The primary goal of such measures is to prevent person-to-person spread of infection in order to interrupt the transmission of disease. In this view, oncologic patients need to be evaluated and balanced whether to continue, stop, or postpone the start of treatments. For radiotherapy with curative intent, prolongation of the prescribed overall treatment time has been linked to inferior clinical outcomes [1,2,3]. Prospective and retrospective studies have also shown that treatment interruptions and prolongation can increase the risk of local recurrence by up to 2% per day for certain malignancies [4].
Despite the current coronavirus pandemic, radiation departments already suffer from non-compliance of patients. The published non-compliance rate is significantly associated with higher age, male gender, advanced stage of tumor, administration of concomitant chemotherapy, and greater travel distance of patients to avail radiotherapy [5].
The understanding of radiobiology and recent advances of technologies had evolved to modified fractionations, which can shorten overall treatment times. Motivations for developing protracted radiotherapy regimens relate not only to tumor control, but also to benefit the patients and health services in terms of convenience and cost. Besides brachytherapy, other altered fractions treatments such as moderated hypofractionation (IGRT) or ablative treatment regimens using stereotactic body radiotherapy (SBRT), are measures, which can reduce departments workload, but all of these are given in a certain number of fractions for each tumor site, in general ranging from 3 to 20 fractions.
During quarantine or social isolation, it is relevant to protect and support oncologic patients, particularly those under radiotherapy whose treatments shall not be interrupted. The use of modified fractions and actions to maintain patients in radiation treatment should be individually tailored. In a recent publication,...


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