Oncologists and cancer surgeons need to open up a debate about which surgical patients should receive radiotherapy instead. My suggestions will follow.
Coronavirus: NHS waiting list 'could hit 10 million this year' - BBC News #COVID19 bbc.co.uk/news/health-52…
I specialize in thoracic & urological malignancy, so will only start #cancerdebate in these areas.
Prostate
1. Offer Active Surveillance or SBRT instead of prostatectomy for vast majority of low risk & low-intermediate risk disease
2. SBRT for intermediate risk disease.
3. If things get really desperate then consider SBRT for higher risk groups as well eg PACE C criteria
Renal:
1. Consider SBRT instead of partial nephrectomy in selected cases (<6cm size).
Bladder
1. Offer RT over surgery in most cases. Surgery for salvage
#cancerdebate
Lung cancer.
1. Consider SBRT over lobectomy for smaller cancers. Careful CT follow up
2. Do more central SBRT eg 50/5
Oligo-metastatic disease
1. Use SBRT over surgery where possible eg tissue not necessary to obtain diagnosis or molecular testing
#cancerdebate
Other considerations:
Surgical training will be hit badly. Need ways to address this.
Radiotherapy capacity is an issue, so we must embrace extreme hypofractionation era. @NHSEngland have already responded well to this by accelerating SABR rollout
Please join the #cancerdebate
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