Objetivo
Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados.

Métodos
A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento.

Resultados
Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible.

Conclusión
Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19.

Authors: Nadia Montero-Oleas[1], Raúl Puente-Vallejo[2], Bárbara León-Micheli[3], Andrés Imbaquingo-Cabrera[2], Mónica Silva[4], Elizabeth Gamarra[5], Byron Álvarez-Rodas[6], Nelson Segovia[3], Pablo Aldaz-Roldan[7], Cristina Nuñez-Silva[2], Karina Zurita-Vivero[2], Alex Carrión[2], José Molina-Jaramillo[6], Andrés Rodríguez-Balarezo[8], Yuri Betancourt[1], Luis De Los Reyes[2]

Affiliation:
[1] Posgrado de Radioterapia, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
[2] Departamento de Radioterapia, Hospital Oncológico SOLCA Núcleo de Quito, Quito, Ecuador
[3] Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
[4] Servicio de Radioterapia, SOLCA Manabí, Núcleo Portoviejo, Portoviejo, Ecuador
[5] Departamento de Radio-Oncología, Instituto Oncológico Nacional Dr. Juan Tanca Marengo, SOLCA-Guayaquil, Guayaquil, Ecuador
[6] Unidad Académica de Salud y Bienestar, Universidad Católica de Cuenca, Cuenca, Ecuador
[7] Escuela de Medicina, Departamento de Ciencias de la Salud, Universidad Técnica Particular de Loja, Loja, Ecuador
[8] Unidad de Radioterapia, Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador

E-mail: nadiamonteromd@gmail.com

Author address:
[1] José Félix Barreiro E15-242
Quito, Ecuador
Código postal: 170209 San Isidro del Inca

Citation: Montero-Oleas N, Puente-Vallejo R, León-Micheli B, Imbaquingo-Cabrera A, Silva M, Gamarra E, et al. Reducing the impact of COVID-19 on radiation oncology units of developing countries: A rapid review and expert consensus. Medwave 2020;20(8):e8012 doi: 10.5867/medwave.2020.08.8012

Submission date: 25/5/2020

Acceptance date: 11/8/2020

Publication date: 7/9/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by three reviewers, double-blind

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