7 Prioritising radiotherapy treatments

7 Prioritising radiotherapy treatments

7.1 If radiotherapy treatments need to be prioritised, use table 1 to help make these decisions. Take into account:

  • balancing the risk of cancer not being treated optimally with the risk of the patient becoming seriously ill from COVID‑19

  • patient-specific risk factors, including comorbidities and any risk of them being immunosuppressed

  • service capacity issues, such as limited resources (workforce, facilities, anaesthetics, equipment).

Table 1 Prioritising radiotherapy treatments

Priority level

Treatment

1

Radical radiotherapy or chemoradiotherapy with curative intent, if:

  • the patient has a category 1 (rapidly proliferating) tumour and

  • treatment has already started and

  • there is little or no possibility of compensating for treatment gaps.

External beam radiotherapy with subsequent brachytherapy, if:

  • the patient has a category 1 (rapidly proliferating) tumour and

  • external beam radiotherapy has already started.

Radiotherapy that has not started yet, if:

  • the patient has a category 1 (rapidly proliferating) tumour and

  • they would normally start treatment, based on clinical need or current cancer treatment waiting times.

2

Urgent palliative radiotherapy, for patients with malignant spinal cord compression who have salvageable neurological function.

3

Radical radiotherapy for a category 2 (less aggressive) tumour, if radiotherapy is the first treatment with curative intent.

Post-operative radiotherapy, if:

  • the patient has a tumour with aggressive biology or

  • they have had surgery, but there is known residual disease.

4

Palliative radiotherapy, where improving symptoms would reduce the need for other interventions.

5

Adjuvant radiotherapy, if:

  • the disease has been completely resected and

  • there is a less than 20% risk of local recurrence at 10 years.

Radical radiotherapy for prostate cancer, in patients having neoadjuvant hormone therapy.

Table adapted from NHS England's specialty guide for the management of cancer patients during the coronavirus pandemic.

For definitions of tumour categories, see the Royal College of Radiologists' guidance on managing unscheduled treatment interruptions.

7.2 Do not treat benign conditions with radiotherapy unless there is an immediate threat to life or function.

7.3 Make prioritisation decisions as part of a multidisciplinary team and ensure each patient is considered on an individual basis. Ensure the reasoning behind each decision is recorded.

7.4 Clearly communicate, with written documentation if possible, what prioritisation is and the reason for the decision to patients, their families and carers.