Cervical cancer in the COVID-19 era – the potential role of adapting newer treatment protocols

Background : The COVID-19 pandemic has resulted in unprecedented problems in cancer management and providing a safe organised work flow for oncological health care systems to operate. The treatment of advanced cervical cancer stage IIB - IVA has received higher priority in most international guidelines for risk adaptation in relation to COVID-19 situation. There is an urgent need to revise the established standard treatment protocol of concurrent chemo-irradiation followed by brachytherapy, usually delivered over 6-7 weeks, which is associated with technical difficulties and would pose risks to both the patient and treating health care personnel. Aims & Objectives : To propose alternative treatment protocols that are supported by scientific data and may be better suited to meet the needs of the unique situation. Methods : A systematic literature search was performed using PubMed and other search engines. The studies evaluated were those published from 1990 to April 2020. The focus was on scientific rationale and non-inferiority with standards of care. Conclusions : The authors propose Simultaneous Integrated Boost for treatment of large volume disease and Stereotactic Body Radiotherapy boost for smaller tumour volumes, where facilities are available. 3DCRT with an integrated or sequential IMRT boost can be considered in institutes with technical limitations.