Management of Locally Advanced Rectal Cancer During The COVID-19 Pandemic: A Necessary Paradigm Change at Memorial Sloan Kettering Cancer Center

Romesser, Paul B.; Wu, Abraham J.; Cercek, Andrea; Smith, J. Joshua; Weiser, Martin; Saltz, Leonard; Garcia-Aguilar, Julio; Crane, Christopher H.

The COVID-19 pandemic will consume significant health care resources. Given concerns for rapidly rising infection rates in the US, impending staffing shortages, and potential for resource re-allocation, we rapidly re-evaluated our rectal cancer practice polices during this public health emergency. Previous to the pandemic we commonly utilized total neoadjuvant therapy (TNT) with a strong preference for long course chemoradiation (LCCRT). In the setting of the ongoing pandemic we now mandate short course radiation therapy (SCRT). Despite multiple randomized trials demonstrating no difference in locoregional recurrence, distant recurrence, or overall survival between SCRT and LRCCT, adaptation of SCRT in the United States has been low given concerns for less tumor downstaging and increased toxicity. In the setting of the ongoing and likely prolonged COVID-19 pandemic, we feel that these concerns must be re-evaluated, as SCRT presents a well-validated alternative that will allow us to meet the needs of a greater number of potentially curable patients, at a time when our resources are severely and acutely constrained.