1
|
Piras A, Venuti V, D’Aviero A, Cusumano D, Pergolizzi S, Daidone A, Boldrini L. Covid-19 and radiotherapy: a systematic review after 2 years of pandemic. Clin Transl Imaging 2022; 10:611-630. [PMID: 35910079 PMCID: PMC9308500 DOI: 10.1007/s40336-022-00513-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 02/08/2023]
Abstract
Introduction Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role.Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians. Methods A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was "Covid AND Radiotherapy" and only original articles in the English language were considered. Results A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results. Discussion RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period.
Collapse
Affiliation(s)
- Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
| | - Valeria Venuti
- Radioterapia Oncologica, Università degli Studi di Palermo, Palermo, Italy
| | - Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari Italy
| | | | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Luca Boldrini
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
2
|
Kumar R, Haresh KP, Sharma DN, Gupta A, Gupta S, Vellaiyan S, Rath GK. Low-dose radiotherapy for COVID 19: A radioimmunological perspective. J Cancer Res Ther 2021; 17:295-302. [PMID: 34121671 DOI: 10.4103/jcrt.jcrt_1045_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The world is fighting the onslaught of COVID 19 for the last 10 months, ever since the first case was reported in December 2019 in Wuhan, China. Now, it has spread to over 200 countries. COVID 19-associated respiratory syndrome is causing a lot of mortality and morbidity. There are reports suggesting that the complications and ARDS associated with COVID 19 is an immune response reaction. The cytokine storm associated with severe cases of COVID 19 acts as a cause of death in many sick patients. It has been shown that COVID 19 is associated with a peculiar immune profile: Decrease in CD3, CD4, CD8, natural killer cell and B-cells; Rise in interleukin (IL)-4, IL-6 and tumor necrosis factor (TNF) alpha; Decrease in IL-10; Decrease in interferon-gamma. Low-dose radiotherapy (LDRT) immunosuppressive features resulting from M2 macrophage phenotype activation, increase in IL-10, transforming growth factor beta, a decrease in IL-6, TNF alpha and an increase in CD3, CD4, and CD8 T cell counts may negate the harmful effects of cytokine release syndrome. Literature review shows that radiation was previously used to treat viral pneumonia with a good success rate. This practice was discontinued in view of the availability of effective antibiotics and antivirals. As there are no scientifically proven treatment for severe COVID 19-associated respiratory distress today, it is prudent that we understand the benefits of LDRT at this critical juncture and take rational decisions to treat the same. This article provides an radioimmunological rationale for the treatment of immune crisis mediated complications in severe cases of COVID 19.
Collapse
Affiliation(s)
- Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Kunhi Parambath Haresh
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi; Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Anil Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subramani Vellaiyan
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi; Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| |
Collapse
|
3
|
Akhtar N, Rajan S, Chakrabarti D, Kumar V, Gupta S, Misra S, Chaturvedi A, Azhar T, Parveen S, Qayoom S, Niranjan P, Tiwari S. Continuing cancer surgery through the first six months of the COVID-19 pandemic at an academic university hospital in India: A lower-middle-income country experience. J Surg Oncol 2021; 123:1177-1187. [PMID: 33567139 PMCID: PMC8014154 DOI: 10.1002/jso.26419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
Background The novel coronavirus pandemic (COVID‐19) hinders the treatment of non‐COVID illnesses like cancer, which may be pronounced in lower‐middle‐income countries. Methods This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID‐19‐related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. Results From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% — 14.12%). Postoperative complications were similar (p = .593, 95% CI: −2.61% — 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID‐19‐related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID‐19‐related mishaps were averted. Conclusions We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID‐19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.
Collapse
Affiliation(s)
- Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deep Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sameer Gupta
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjeev Misra
- Director, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arun Chaturvedi
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tashbihul Azhar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shirin Parveen
- Department of Anaesthesiology, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Sumaira Qayoom
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Palavalasa Niranjan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shashwat Tiwari
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
4
|
COVID-19 pneumonia treated with ultra-low doses of radiotherapy (ULTRA-COVID study): a single institution report of two cases. Strahlenther Onkol 2021; 197:429-437. [PMID: 33502567 PMCID: PMC7839288 DOI: 10.1007/s00066-020-01743-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022]
Abstract
Introduction Since the outbreak of coronavirus disease 2019 (COVID-19) pandemic, healthcare systems have focused their efforts into finding a treatment to avoid the fatal outcomes of severe acute respiratory syndrome due to coronavirus‑2 (SARS-CoV-2). Benefits and risks of systemic treatments remain unclear, with multiple clinical trials still ongoing. Radiotherapy could play a role in reducing the inflammatory response in the lungs and relieve life-threatening symptoms. Methods We designed a prospective study of Ultra-Low Doses of Therapy with Radiation Applied to COVID-19 (ULTRA-COVID) for patients who suffer pneumonia, are not candidates for invasive mechanical ventilation and show no improvement with medical therapy. Results We present the preliminary results of two patients diagnosed with COVID-19 pneumonia treated with ULTRA-COVID. After one radiotherapy session, significant clinical response and a good radiological response was observed in both cases, resulting in both patients being discharged from hospital in less than 2 weeks after radiation treatment. Conclusion Preliminary clinical and radiological results suggest a potential benefit of treating COVID-19 pneumonia with ULTRA-COVID. ClinicalTrials.gov Identifier: NCT04394182
Collapse
|
5
|
Matuschek C, Fischer JC, Combs SE, Fietkau R, Corradini S, Zänker K, Bölke E, Djiepmo-Njanang FJ, Tamaskovics B, Fischer JE, Stuschke M, Pöttgen C, Förster R, Zwahlen DR, Papachristofilou A, Ganswindt U, Pelka R, Schneider EM, Feldt T, Jensen BEO, Häussinger D, Knoefel WT, Kindgen-Milles D, Pedoto A, Grebe O, van Griensven M, Budach W, Haussmann J. Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland. Strahlenther Onkol 2020; 196:1068-1079. [PMID: 32914236 PMCID: PMC7483062 DOI: 10.1007/s00066-020-01681-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. METHODS We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. RESULTS The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV‑2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV‑2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. CONCLUSION Most ROIs reported a deep impact of SARS-CoV‑2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care.
Collapse
Affiliation(s)
- Christiane Matuschek
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | - Johannes C. Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum Munich, Munich, Germany
- Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University of Erlangen, Erlangen, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Edwin Bölke
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | | | - Balint Tamaskovics
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | | | - Martin Stuschke
- Department of Radiation Oncology, University Essen, Essen, Germany
| | | | - Robert Förster
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Zurich, Switzerland
| | - Daniel R. Zwahlen
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, University of Zurich, Zurich, Switzerland
| | | | - Ute Ganswindt
- Department of Radiation Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Rainer Pelka
- Institute for Applied Statistics, Unterföhring/Munich, Germany
| | - E. Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Björn Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Duesseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department for General Visceral and Pediatric Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Detlef Kindgen-Milles
- Department of Intensive Care Medicine, Heinrich Heine University, Dusseldorf, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Olaf Grebe
- Department for Cardiology, Rhythmology and Intensive Care Medicine, Evangelic Hospital, Dusseldorf, Germany
| | - Martijn van Griensven
- MERLN Institute for Technology-Inspired Regenerative Medicine, Department cBITE, Maastricht University, Maastricht, The Netherlands
| | - Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| | - Jan Haussmann
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Duesseldorf, Germany
| |
Collapse
|
6
|
Nestle U, Krause M. Radiotherapy and COVID-19-everything under control or just the start of a long story? Strahlenther Onkol 2020; 196:1065-1067. [PMID: 33231738 PMCID: PMC7684561 DOI: 10.1007/s00066-020-01704-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ursula Nestle
- Klinik für Strahlentherapie und Radioonkologie, Kliniken Mariahilf Mönchengladbach, Mönchengladbach, Germany. .,Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany. .,German Cancer Consortium (DKTK) partner site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Mechthild Krause
- German Cancer Consortium (DKTK) partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany.,OncoRay-National Center for Radiation Research in Oncology: Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Dept. of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Faculty of Medicine, University Hospital C.G. Carus Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| |
Collapse
|
7
|
Hertzog RG, Bicheru SN. Radiotherapy in the fight against pneumonia associated with SARS-CoV-2. Int J Radiat Biol 2020; 96:1319-1322. [PMID: 32931359 DOI: 10.1080/09553002.2020.1822560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
8
|
Salomaa S, Bouffler SD, Atkinson MJ, Cardis E, Hamada N. Is there any supportive evidence for low dose radiotherapy for COVID-19 pneumonia? Int J Radiat Biol 2020; 96:1228-1235. [DOI: 10.1080/09553002.2020.1786609] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sisko Salomaa
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
- STUK-Radiation and Nuclear Safety Authority, Helsinki, Finland
| | - Simon D. Bouffler
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Didcot, UK
| | - Michael J. Atkinson
- Institute of Radiation Biology, Helmholtz-Center Munich, National Research Centre for Health and Environment, Neuherberg, Germany
| | - Elisabeth Cardis
- Campus Mar, Barcelona Biomedical Research Park (PRBB), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Komae, Japan
| |
Collapse
|