Reducing the impact of COVID-19 on radiation oncology units of developing countries: A rapid review and expert consensus

Objective To general recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources. Methods We did a rapid review of the literature,searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified. Delphi method, the consensus was reached among 14 certificated radio -oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed. Results A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection.Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can he omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible. Conclusions We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.