Daily Practice

COVID-19 Clinical Guidance

When the COVID-19 pandemic first hit in March 2020, ASTRO compiled the following selection of resources for radiation oncology professionals. The resources were developed by clinical teams and based on the best available information at the time they were posted. Since that time, the COVID-19 vaccine and booster became available. Additionally, the CDC has imposed new isolation and quarantine guidelines. Physicians and their patients should consult the CDC, their institution’s infection control protocol and state and local public health rules for guidance regarding quarantine, isolation, face coverings and vaccines. Full vaccination, including a booster vaccine, according to the schedule recommended by the CDC, is recommended for all HCWs and patients, as clinically indicated.
The clinical guidance below is not meant to replace clinical judgment, but to help treatment teams strengthen their clinical management of patients and support decision-making processes during the COVID-19 pandemic.

ASTRO Recommendation on COVID-19 Vaccination for Cancer Patients Receiving Radiation Therapy

Cancer patients may have an increased risk of contracting COVID-19 and more severe disease if infected. According to the Centers for Disease Control and Prevention (CDC), “Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. mRNA COVID-19 vaccines may be administered to people with underlying medical conditions provided they have not had a severe or immediate allergic reaction to any of the ingredients in the vaccine.” These guidelines also apply to cancer patients. The mRNA COVID-19 vaccines do not include any virus, and there is no risk of contracting the infection from the vaccine.

Patients who have cancer, as well as those who have received treatment for cancer, may be immune compromised, but these patients may still receive COVID-19 vaccines as long as there is no increased risk of reaction to any of the components of the vaccine. ASTRO encourages cancer patients who are actively receiving treatment such as radiation therapy to consult with their oncologists about the timing for vaccination, injection location and any unique considerations relevant for their treatments. Individuals with a prior history of cancer who are not in active treatment are encouraged to seek vaccination whenever it is made available to them.

Clinical Guidance


Johns Hopkins University Program in a Pandemic
April 6, 2020

Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic
April 1, 2020

UW Radiation Oncology COVID-10 Clinical Care Approach
March 27, 2020

NICE COVID-19 rapid guideline: delivery of radiotherapy
March 28, 2020

Disease Specific

Head and Neck

ASTRO/ESTRO Practice Recommendations for Risk-adapted Head and Neck Cancer Radiotherapy During the COVID-19 Pandemic
April 9, 2020


ASTRO/ESTRO Practice Recommendations for Lung Cancer Radiotherapy During the COVID-19 Pandemic
April 6, 2020

Sterilization Guidance

Fox Chase Cancer Center N95 Reprocessing Plan
March 29, 2020

UW Radiation Oncology COVID-19 Approach Disease Site Prioritization Scheme
March 26, 2020

Hypofractionation has been demonstrated to be equally effective as standard conventional courses of radiation therapy in specific clinical situations. ASTRO supports the use of hypofractionated regimens in disease sites where the treating radiation oncologist determines it is a reasonable approach.

Radiation Therapy for the Whole-Breast
Smith, B.D. et al, 2018

Hypofractionation for Localized Prostate Cancer
Morgan, S.C., 2018

Tumor Radiobiology of SRS and SBRT
Brown, J.M., 2013

View additional resources shared by cancer centers.

Last updated: 5/13/2022 2:17:46 PM