Role of altered fractionation in radiation therapy with or without chemotherapy in management of carcinoma cervix: Time to revisit in the current COVID-19 pandemic

Severe acute respiratory syndrome coronavirus 2 as COVID-19 virus has affected the entire world and so to the cancer care and health-care facility. Cancer cervix is one of the common malignancies among women in developing and underdeveloped countries. Various challenges are being faced by patients and health-care providers to deliver optimal treatment under prescribed time frame. Faster delivery of whole treatment is desirable in the current pandemic. Overall treatment time in cancer cervix has prognostic value. Adoption of altered fractionation to delivered external beam radiation therapy could be a method for faster delivery of whole treatment. Altered fractionation such as hyperfractionation (HFX), hypofractionation, and accelerated fraction alone or with HFX has already been experimented for the past three decades. The total duration of treatment has been significantly reduced without addition of much toxicity. Few studies had also highlighted the feasibility of addition of chemotherapy to such fractionation schedule. However, prospective studies are still warranted to generate data to further support its use in the future.