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SiteSubtopicEligibilityTrial/GroupDose/fxDose constraintsNotesEvidenceLinkLinkLink
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Head and neckDefinitive
Hypofx		locally advancedRCR
Brazil		55 Gy/ 20 fxBED calculationsThe ASTRO-ESTRO panel had strong agreement that 2.41-3.0 Gy per fraction was acceptable during late pandemic phases. Concurrent chemo was recommended in mild hypofractionation of ≤2.4 Gy per fraction.phase IIhttp://www.ccsenet.org/journal/index.php/cco/article/view/37087https://bmccancer.biomedcentral.com/track/pdf/10.1186/s12885-018-4893-5https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf
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Head and neckPost-op
Hypofx		locally advancedRCR
Brazil		50-5 Gy/ 20-22 fxBED calculationsextrapolation from definitivehttp://www.ccsenet.org/journal/index.php/cco/article/view/37087https://bmccancer.biomedcentral.com/track/pdf/10.1186/s12885-018-4893-5
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Head and neckDefinitive
Hypofx		locally advancedBrazil54 Gy/ 18 fxBED calculationsretrospectivehttps://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdfhttps://www.ncbi.nlm.nih.gov/pubmed/19475548https://www.ncbi.nlm.nih.gov/pubmed/25379320
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Head and neckDefinitive
Hypofx		oral cavity post opKorea50 Gy/ 20 fxBED calculationsretrospectivehttps://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdfhttps://www.e-roj.org/m/journal/view.php?number=1432
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Head and neckDefinitive
Hypofx		locally advancedASTRO-ESTRO guidelines62.5-64 Gy/ 25 fxBED calculationsThe ASTRO-ESTRO panel had strong agreement that 2.41-3.0 Gy per fraction was acceptable during late pandemic phases. Concurrent chemo was recommended in mild hypofractionation of ≤2.4 Gy per fraction.phase IIhttps://pubmed.ncbi.nlm.nih.gov/29478732/https://pubmed.ncbi.nlm.nih.gov/25279959/https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf
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Head and neckDefinitive
HPV+ 		localized HPV+NRG HN-00260 Gy/ 30 fxConventionalConsider planning first to 70 Gy, then at time of 60 Gy consider end of treatment based on status of patient, clinical response, and viral status in your community. Alternatively, if a patient has tested positive, ending at 60 Gy may be prudent.phase IIhttps://www.redjournal.org/article/S0360-3016%2819%2933673-9/fulltext
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Head and neck post-op
ENE 		ENE post-opMDACC60-63 Gy for HPV-
60 Gy for HPV+		Conventional60 Gy may also be appropriate for any extent of ENE in HPV+ based on NRG HN002. In the MDACC dose escalation study, small foci of ENE were allowed in the 60 Gy group. 1https://www.redjournal.org/article/S0360-3016(17)30633-8/abstract
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Head and neckDefinitive, no chemononchemo, eligible for curative RTDAHANCA66 Gy/ 33 fx, 6 per weekBED calculationsAlthough not extremely shortened, this regimen does offer an incremental shortening over 35 treatments.1https://www.ncbi.nlm.nih.gov/pubmed/14511925https://www.ncbi.nlm.nih.gov/pubmed/26255764
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Head and neckDefinitive, no chemononchemo, eligible for curative RTRTOG 002266 Gy/ 30 fx dailyConventionalPhase IIhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846217/pdf/nihms113223.pdf
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Head and neckDefinitive, split courseanySplit course
Duke
Intergroup		70 Gy, 2 week break at 40 GyConventionalAlthough proven inferior to conventional fractionation in trials, split course could prove useful in truly emergent situations, such as with a patient who is COVID+, high local prevalence, or severely reduced staffing and resources. Favor continuing treatment per standard fractionation with PPE if feasible in your department. https://www.nejm.org/doi/full/10.1056/NEJM199806183382503https://www.nejm.org/doi/full/10.1056/NEJM199806183382503
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Head and neckReduced volumeanyACRIN 6685
Washington U		omit neck in PET -ve and/or pN0 neck

omit post-op tonsil bed if no indication to tx		To optimize performance status, especially out of concern that COVID infection could occur at any time, consideration should be given to reduce volume as much as possible. ACRIN showed a 94% NPV in PET negative necks before dissection. Wash U's study showed high LC when RT was omitted to a dissected neck that was pN0. In the AVOID trial, omission of RT to the tonsil post-op bed was safe if there were indications to treat the neck but not the post-op bed. phase IIhttps://pubmed.ncbi.nlm.nih.gov/31785337/
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Head and necksurgeryresectable tumors-omission of surgeryIf there are already factors present to mandate adjuvant RT, then the patient should proceed to definitive RT or chemo RT and surgery avoided, especially for HPV+ tumors.
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Head and neckinduction chemon/aASTRO-ESTROinduction chemo
(not recommended)		https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Thomson-et-al(ROB).pdf
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Head and NeckHypofxGlottic T1Royal Marsden50-52.5 Gy in 15-16 fxBED calculationsb Retrospectivehttps://www.ncbi.nlm.nih.gov/pubmed/12972304https://www.ncbi.nlm.nih.gov/pubmed/19375900
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Head and NeckHypofxGlottic T2Royal Marsden55 Gy in 20 fxBED calculations0,https://www.ncbi.nlm.nih.gov/pubmed/16635034https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580345/
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SkinPost-op
Hypofx		locally advancedRANZCR50-5 Gy/ 20-22 fxBED calculationsextrapolation from definitivehttp://www.ccsenet.org/journal/index.php/cco/article/view/37087
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SkinHDRHDR20 Gy/ 5 fx daily
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SkinMerkelhypofxNCCN8-24 Gy/1-3 fxhttps://www.nccn.org/covid-19/pdf/NCCN-NMSC-Ref2.pdfhttps://www.nccn.org/covid-19/pdf/NCCN-NMSC-Ref1.pdf
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SkinSCC, MCca, RareSCC, MCca, RareRCR32.5 Gy/ 4 fx
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SkinSCC, MCca, RareSCC, MCca, RareRCR40 Gy/ 8 fx
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SkinSCC, MCca, RareSCC, MCca, RareRCR50 Gy/ 15 fxBED calculations
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