Guidelines on Radiation Therapy for Breast Cancer during COVID-19 (2020)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 27, 2020

The guideline on radiation therapy (RT) for patients with breast cancer during the COVID-19 pandemic was released in April, 2020 by an international group.[1]

Omit RT for patients age 65 years and over (or younger patients with relevant co-morbidities) who have invasive breast cancers that are up to 30 mm with clear margins, grade 1-2, estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative, and node negative who are planned for treatment with endocrine therapy.

Deliver RT in 5 fractions only for all patients requiring RT who have node-negative tumors that do not require a boost. Options include 28-30 Gy in once-weekly fractions over 5 weeks or 26 Gy in 5 daily fractions over 1 week, as per the FAST and FAST Forward trials, respectively.

To reduce fractions and/or complexity, omit boost RT in the vast majority of patients. Exceptions are in patients ≤40 years old and those older than 40 years who have significant risk factors for local relapse.

Consider omitting nodal RT in post-menopausal women who require whole-breast RT following sentinel lymph node biopsy and primary surgery for T1, ER positive, HER2 negative, grade 1-2 tumors with 1-2 macrometastases.

Use moderate hypofractionation for all breast/chest wall and nodal RT (eg, 40 Gy in 15 fractions over 3 weeks).

For more information, see the Coronavirus Resource Center and Breast Cancer. For more Clinical Practice Guidelines, please go to Guidelines.


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