Thread by @cpeedell

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