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Dinakar K, Jakka MK, Vemannagari PKR, Mohan A, Subramanian BV, Bodagala VD, Bhuma V, Das P, Bonala SR, Vutukuru VR. Efficacy of low-dose lung radiotherapy in the management of COVID-19 patients: a randomised, open-label study. Br J Radiol 2023; 96:20230022. [PMID: 37751170 PMCID: PMC10646638 DOI: 10.1259/bjr.20230022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Evaluate role of low-dose radiotherapy (LDRT) in COVID-19 pneumonia. METHODS Sixty-five patients 40 years or older tested positive for COVID-19 reverse transcriptase-polymerase chain reaction with mild to moderate acute respiratory distress syndrome (ARDS), were randomised 1:1, from 4 June 2021, to either best standard of care (control arm) according to the Indian Council of Medical Research guidelines or a single dose of LDRT (LDRT-0.5Gy) to both lungs along with best standard of care (experimental arm). The primary outcome was either progression to severe disease (PaO2/FiO2 ratio <100 mmHg) within 28 days of randomisation or all-cause mortality at 28 days. If the primary outcome could have been prevented, it was considered "favourable"; if not, it was considered "unfavourable." RESULTS Thirty-three patients were allocated to experimental arm, 32 to control arm. An intention to treat analysis was performed. Unfavourable outcome was seen in 5 (15.2%) patients in experimental arm, vs , 12 (37.5%) patients in control arm, odds of an unfavourable outcome in experimental arm were 0.3, 95% CI 0.09-0.97; two-sided p = 0.04. Four and five patients died in experimental and control arm, respectively. No radiation-induced toxicity was observed. CONCLUSION LDRT reduced the number of patients with unfavourable outcome at 28 days. ADVANCES IN KNOWLEDGE One of the few randomised studies showing reduced unfavourable outcome in mild to moderate ARDS COVID-19 patients receiving LDRT.CTRI/2021/06/034001, Clinical Trials Registry - India (ICMR-NIMS).
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Affiliation(s)
- Kootala Dinakar
- Department of Radiation Oncology, Government Medical College, Ananthapur, Andhra Pradesh, India
| | - Mohan Krishna Jakka
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | - Pavan Kumar Reddy Vemannagari
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | - Alladi Mohan
- Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Bala Venkat Subramanian
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | | | - Vengamma Bhuma
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Pranabandhu Das
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | - Sreenivasa Rao Bonala
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
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Hussien SM. The impact of ionizing radiation compared to drug-induced immunological changes. Can J Physiol Pharmacol 2023; 101:672-681. [PMID: 37767909 DOI: 10.1139/cjpp-2023-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Ionizing radiation (IR) activates several signaling pathways. This study shows the impact of acute low-dose IR on crucial cytokines involved in cell-mediated immunity. The immunomodulatory effects of 0.25 and 0.5 Gray (Gy) gamma rays and standard immunomodulatory drugs (cyclophosphamide) on blood counts and significant pro-inflammatory cytokines implicated in various inflammatory conditions were tested in 20 rats. Examined was the effect of acute low doses on critical cytokines, which could be utilized as an alternative to current immunosuppressive drugs. One day post-irradiation, serum levels of interferon-gamma (INF-γ), tumor necrosis factor-alpha, and interleukin-2/1-beta were measured. A 0.25 Gy exposure did not affect the detected cytokines or blood cell count compared to the nonirradiated group. On the other hand, 0.5 Gy raises the majority of the immunologically examined cytokines except for INF-γ. Except for INF-γ, cyclophosphamide reduces all of the cytokines examined. As a result, low-dose IR has a less negative influence on essential inflammatory cytokines, permitting its use. More research is needed to determine how low amounts could be used in different immunological disorders.
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Affiliation(s)
- Soha M Hussien
- Radiation Safety Department, Nuclear and Radiological Safety Research Center, Egyptian Atomic Energy Authority, Cairo, Egypt
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Hamada N. Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions. Radiat Res 2023; 200:188-216. [PMID: 37410098 DOI: 10.1667/rade-23-00030.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023]
Abstract
For radiation protection purposes, noncancer effects with a threshold-type dose-response relationship have been classified as tissue reactions (formerly called nonstochastic or deterministic effects), and equivalent dose limits aim to prevent occurrence of such tissue reactions. Accumulating evidence demonstrates increased risks for several late occurring noncancer effects at doses and dose rates much lower than previously considered. In 2011, the International Commission on Radiological Protection (ICRP) issued a statement on tissue reactions to recommend a threshold of 0.5 Gy to the lens of the eye for cataracts and to the heart and brain for diseases of the circulatory system (DCS), independent of dose rate. Literature published thereafter continues to provide updated knowledge. Increased risks for cataracts below 0.5 Gy have been reported in several cohorts (e.g., including in those receiving protracted or chronic exposures). A dose threshold for cataracts is less evident with longer follow-up, with limited evidence available for risk of cataract removal surgery. There is emerging evidence for risk of normal-tension glaucoma and diabetic retinopathy, but the long-held tenet that the lens represents among the most radiosensitive tissues in the eye and in the body seems to remain unchanged. For DCS, increased risks have been reported in various cohorts, but the existence or otherwise of a dose threshold is unclear. The level of risk is less uncertain at lower dose and lower dose rate, with the possibility that risk per unit dose is greater at lower doses and dose rates. Target organs and tissues for DCS are also unknown, but may include heart, large blood vessels and kidneys. Identification of potential factors (e.g., sex, age, lifestyle factors, coexposures, comorbidities, genetics and epigenetics) that may modify radiation risk of cataracts and DCS would be important. Other noncancer effects on the radar include neurological effects (e.g., Parkinson's disease, Alzheimer's disease and dementia) of which elevated risk has increasingly been reported. These late occurring noncancer effects tend to deviate from the definition of tissue reactions, necessitating more scientific developments to reconsider the radiation effect classification system and risk management. This paper gives an overview of historical developments made in ICRP prior to the 2011 statement and an update on relevant developments made since the 2011 ICRP statement.
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Affiliation(s)
- Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
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Hussien SM. The immunomodulatory properties of low-level ionizing radiation as a potential treatment for COVID-19's life-threatening symptoms. Eur J Med Res 2023; 28:73. [PMID: 36774511 PMCID: PMC9918814 DOI: 10.1186/s40001-023-00999-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 01/06/2023] [Indexed: 02/13/2023] Open
Abstract
Public health experts are looking into the current coronavirus outbreak to see if there are any ways to prevent potentially fatal symptoms. Low-Dose Radiotherapy (LD-RT) induces anti-inflammatory cytokine responses that act as a counterweight to pro-inflammatory cytokines, potentially providing therapeutic benefits for COVID-19-related diseases associated with significant morbidity and mortality. This study will look into positive immuno-radiological reactions to see if they are feasible, practicable, and effective in lowering the critical inflammatory condition of the crucial stage COVID-19. This study aims to investigate the use of low-dose lung radiation in bacterial and viral pneumonia, as well as to provide a treatment plan for COVID-19-associated pneumonia. This article discusses the evidence for and against LD-RT theories in COVID-19 patients. The use of LD-RT at various stages of COVID-19 appears to be beneficial, with fewer side effects than other currently being studied treatments.
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Affiliation(s)
- Soha M. Hussien
- grid.429648.50000 0000 9052 0245Radiation Safety Department, Nuclear and Radiological Safety Research Center, Egyptian Atomic Energy Authority, Cairo, Egypt
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5
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Little MP, Zhang W, van Dusen R, Hamada N, Bugden M, Cao M, Thomas K, Li D, Wang Y, Chandrashekhar M, Khan MK, Coleman CN. Low-dose radiotherapy for COVID-19 pneumonia and cancer: summary of a recent symposium and future perspectives. Int J Radiat Biol 2023; 99:357-371. [PMID: 35511152 DOI: 10.1080/09553002.2022.2074165] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The lessons learned from the Coronavirus Disease 2019 (COVID-19) pandemic are numerous. Low dose radiotherapy (LDRT) was used in the pre-antibiotic era as treatment for bacterially/virally associated pneumonia. Motivated in part by these historic clinical and radiobiological data, LDRT for treatment of COVID-19-associated pneumonia was proposed in early 2020. Although there is a large body of epidemiological and experimental data pointing to effects such as cancer at low doses, there is some evidence of beneficial health effects at low doses. It has been hypothesized that low dose radiation could be combined with immune checkpoint therapy to treat cancer. We shall review here some of these old radiobiological and epidemiological data, as well as the newer data on low dose radiation and stimulated immune response and other relevant emerging data. The paper includes a summary of several oral presentations given in a Symposium on "Low dose RT for COVID and other inflammatory diseases" as part of the 67th Annual Meeting of the Radiation Research Society, held virtually 3-6 October 2021.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD, USA
| | - Wei Zhang
- Radiation Effects Department, UK Health Security Agency (UKHSA), Chilton, UK
| | - Roy van Dusen
- Information Management Services, Silver Spring, MD, USA
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Komae, Japan
| | - Michelle Bugden
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Meiyun Cao
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Kiersten Thomas
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Deyang Li
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Yi Wang
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, Chalk River, Canada.,Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Megha Chandrashekhar
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Mohammad K Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - C Norman Coleman
- Radiation Research Program, Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, DHHS, Rockville, MD, USA
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Ricci PF, Calabrese EJ. Resolving an Open Science-policy question: Should the LNT still be an omnibus regulatory assumption? THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 825:153917. [PMID: 35189226 DOI: 10.1016/j.scitotenv.2022.153917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 06/14/2023]
Abstract
Regulatory analyses, modeling the carcinogenic effect of ionizing radiations (IR) (e.g., alpha and beta particles, x-, and gamma rays, neutrons) and chemicals continue to use the linear no-threshold (LNT) model from zero to some low dose. The LNT is an omnibus causal default in regulatory occupational and health risk analysis. Its use raises four issues that make this default an open question. The first is that the LNT applied to study a single agent excludes co-exposure to other known risk factors: physical, dietary, socio-economic, and other. Causation is inappropriately specified because cancer incidence is imputed to the single agent's doses, although most cancers are multifactorial diseases. The second, linear interpolation from high to zero dose and response, is incorrect because biological and epidemiological evidence identify different mechanisms and modes of action at those doses. Third, additivity of exposure effect to background effect is questionable and certainly variable. Fourth, the default overestimates the probabilities and consequences at low doses, supplanting rational decision-making in which alternative models may be more or less likely to be correct. Recent converging scientific evidence against the LNT hypothesis answers the open question. The LNT use in regulation conflates science with administrative ease and risk aversion by policymakers. It should be replaced by models that are based on biologically motivated mechanistic understandings within an evolutionary biology framework that integrates adaptive strategies/processes in their formulation.
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Affiliation(s)
- Paolo F Ricci
- University of Bologna, Environmental Management, Ravenna Campus, Scienze Ambientali, Via Sant'Alberto 163, 48123, Ravenna, Italy.
| | - Edward J Calabrese
- Environmental Health Sciences, Morrill I, N344, University of Massachusetts, Amherst, MA 01003, USA.
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Sanmamed N, Alcantara P, Gómez S, Bustos A, Cerezo E, Gaztañaga M, Doval A, Corona J, Rodriguez G, Cabello N, Duffort M, Ortuño F, de Castro J, López A, Fuentes M, Sanz A, Vazquez M. Low-dose radiation therapy in the management of COVID-19 pneumonia (LOWRAD-Cov19). Final results of a prospective phase I-II trial. Radiother Oncol 2022; 171:25-29. [PMID: 35367528 PMCID: PMC8968128 DOI: 10.1016/j.radonc.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
Background and purpose Material and methods Results Conclusions
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Affiliation(s)
- Noelia Sanmamed
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain.
| | - Pino Alcantara
- Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain; Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine. Complutense University of Madrid, Spain
| | - Sara Gómez
- Radiology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Ana Bustos
- Radiology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Elena Cerezo
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Miren Gaztañaga
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - Anxela Doval
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Juan Corona
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine. Complutense University of Madrid, Spain
| | - Gabriel Rodriguez
- Medical Physics Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Noemi Cabello
- Internal Medicine Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Mercedes Duffort
- Internal Medicine Department, Infanta Leonor Hospital, Madrid, Spain
| | | | | | - Amanda López
- Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - Manuel Fuentes
- Preventive Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Alvaro Sanz
- Medical Oncology Department, Rio Hortega Hospital, Valladolid, Spain
| | - Manuel Vazquez
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine. Complutense University of Madrid, Spain
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8
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The Role of Ionizing Radiation for Diagnosis and Treatment against COVID-19: Evidence and Considerations. Cells 2022; 11:cells11030467. [PMID: 35159277 PMCID: PMC8834503 DOI: 10.3390/cells11030467] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 million people infected and more than 5 million deaths, numbers that are escalating on a daily basis. Frontline health workers and scientists diligently fight to alleviate life-threatening symptoms and control the spread of the disease. There is an urgent need for better triage of patients, especially in third world countries, in order to decrease the pressure induced on healthcare facilities. In the struggle to treat life-threatening COVID-19 pneumonia, scientists have debated the clinical use of ionizing radiation (IR). The historical literature dating back to the 1940s contains many reports of successful treatment of pneumonia with IR. In this work, we critically review the literature for the use of IR for both diagnostic and treatment purposes. We identify details including the computed tomography (CT) scanning considerations, the radiobiological basis of IR anti-inflammatory effects, the supportive evidence for low dose radiation therapy (LDRT), and the risks of radiation-induced cancer and cardiac disease associated with LDRT. In this paper, we address concerns regarding the effective management of COVID-19 patients and potential avenues that could provide empirical evidence for the fight against the disease.
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Jackson MR, Stevenson K, Chahal SK, Curley E, Finney GE, Gutierrez-Quintana R, Onwubiko E, Rupp A, Strathdee K, Williams K, MacLeod MKL, McSharry C, Chalmers AJ. Low-Dose Lung Radiation Therapy for COVID-19 Lung Disease: A Preclinical Efficacy Study in a Bleomycin Model of Pneumonitis. Int J Radiat Oncol Biol Phys 2022; 112:197-211. [PMID: 34478832 PMCID: PMC8406661 DOI: 10.1016/j.ijrobp.2021.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Low-dose whole lung radiation therapy (LDLR) has been proposed as a treatment for patients with acute respiratory distress syndrome associated with SARS-CoV-2 infection, and clinical trials are underway. There is an urgent need for preclinical evidence to justify this approach and inform dose, scheduling, and mechanisms of action. METHODS AND MATERIALS Female C57BL/6 mice were treated with intranasal bleomycin sulfate (7.5 or 11.25 units/kg, day 0) and then exposed to whole lung radiation therapy (0.5, 1.0, or 1.5 Gy, or sham; day 3). Bodyweight was measured daily, and lung tissue was harvested for histology and flow cytometry on day 10. Computed tomography lung imaging was performed before radiation (day 3) and pre-endpoint (day 10). RESULTS Bleomycin caused pneumonitis of variable severity, which correlated with weight loss. LDLR at 1.0 Gy was associated with a significant increase in the proportion of mice recovering to 98% of initial bodyweight, and a proportion of these mice exhibited less severe histopathologic lung changes. Mice experiencing moderate initial weight loss were more likely to respond to LDLR than those experiencing severe initial weight loss. In addition, LDLR (1.0 Gy) significantly reduced bleomycin-induced increases in interstitial macrophages, CD103+ dendritic cells (DCs), and neutrophil-DC hybrids. Overall, bleomycin-treated mice exhibited significantly higher percentages of nonaerated lung in left than right lungs, and LDLR (1.0 Gy) limited further reductions in aerated lung volume in right but not left lungs. LDLR at 0.5 and 1.5 Gy did not improve bodyweight, flow cytometric, or radiologic readouts of bleomycin-induced pneumonitis. CONCLUSIONS Our data support the concept that LDLR can ameliorate acute inflammatory lung injury, identify 1.0 Gy as the most effective dose, and provide evidence that it is more effective in the context of moderate than severe pneumonitis. Mechanistically, LDLR at 1.0 Gy significantly suppressed bleomycin-induced accumulation of pulmonary interstitial macrophages, CD103+ DCs, and neutrophil-DC hybrids.
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Affiliation(s)
- Mark R Jackson
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | | | - Sandeep K Chahal
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Emer Curley
- Cancer Research UK Beatson Institute, Glasgow, United Kingdom
| | - George E Finney
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Rodrigo Gutierrez-Quintana
- Institute of Cancer Sciences, University of Glasgow, United Kingdom; School of Veterinary Medicine, University of Glasgow, United Kingdom
| | | | - Angie Rupp
- School of Veterinary Medicine, University of Glasgow, United Kingdom
| | - Karen Strathdee
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Karin Williams
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Megan K L MacLeod
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Charles McSharry
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
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Alo UR, Nkwo FO, Nweke HF, Achi II, Okemiri HA. Non-Pharmaceutical Interventions against COVID-19 Pandemic: Review of Contact Tracing and Social Distancing Technologies, Protocols, Apps, Security and Open Research Directions. SENSORS (BASEL, SWITZERLAND) 2021; 22:280. [PMID: 35009822 PMCID: PMC8749862 DOI: 10.3390/s22010280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 Pandemic has punched a devastating blow on the majority of the world's population. Millions of people have been infected while hundreds of thousands have died of the disease throwing many families into mourning and other psychological torments. It has also crippled the economy of many countries of the world leading to job losses, high inflation, and dwindling Gross Domestic Product (GDP). The duo of social distancing and contact tracing are the major technological-based non-pharmaceutical public health intervention strategies adopted for combating the dreaded disease. These technologies have been deployed by different countries around the world to achieve effective and efficient means of maintaining appropriate distance and tracking the transmission pattern of the diseases or identifying those at high risk of infecting others. This paper aims to synthesize the research efforts on contact tracing and social distancing to minimize the spread of COVID-19. The paper critically and comprehensively reviews contact tracing technologies, protocols, and mobile applications (apps) that were recently developed and deployed against the coronavirus disease. Furthermore, the paper discusses social distancing technologies, appropriate methods to maintain distances, regulations, isolation/quarantine, and interaction strategies. In addition, the paper highlights different security/privacy vulnerabilities identified in contact tracing and social distancing technologies and solutions against these vulnerabilities. We also x-rayed the strengths and weaknesses of the various technologies concerning their application in contact tracing and social distancing. Finally, the paper proposed insightful recommendations and open research directions in contact tracing and social distancing that could assist researchers, developers, and governments in implementing new technological methods to combat the menace of COVID-19.
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Affiliation(s)
- Uzoma Rita Alo
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
| | - Friday Onwe Nkwo
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
| | - Henry Friday Nweke
- Centre for Research in Machine Learning, Artificial Intelligence and Network Systems, Computer Science Department, Ebonyi State University, P.M.B 053, Abakaliki 480211, Ebonyi State, Nigeria;
| | - Ifeanyi Isaiah Achi
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
| | - Henry Anayo Okemiri
- Department of Computer Science and Informatics, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo P.M.B 1010, Abakaliki 480211, Ebonyi State, Nigeria; (F.O.N.); (I.I.A.); (H.A.O.)
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11
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Boice JD, Quinn B, Al-Nabulsi I, Ansari A, Blake PK, Blattnig SR, Caffrey EA, Cohen SS, Golden AP, Held KD, Jokisch DW, Leggett RW, Mumma MT, Samuels C, Till JE, Tolmachev SY, Yoder RC, Zhou JY, Dauer LT. A million persons, a million dreams: a vision for a national center of radiation epidemiology and biology. Int J Radiat Biol 2021; 98:795-821. [PMID: 34669549 PMCID: PMC10594603 DOI: 10.1080/09553002.2021.1988183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Epidemiologic studies of radiation-exposed populations form the basis for human safety standards. They also help shape public health policy and evidence-based health practices by identifying and quantifying health risks of exposure in defined populations. For more than a century, epidemiologists have studied the consequences of radiation exposures, yet the health effects of low levels delivered at a low-dose rate remain equivocal. MATERIALS AND METHODS The Million Person Study (MPS) of U.S. Radiation Workers and Veterans was designed to examine health effects following chronic exposures in contrast with brief exposures as experienced by the Japanese atomic bomb survivors. Radiation associations for rare cancers, intakes of radionuclides, and differences between men and women are being evaluated, as well as noncancers such as cardiovascular disease and conditions such as dementia and cognitive function. The first international symposium, held November 6, 2020, provided a broad overview of the MPS. Representatives from four U.S. government agencies addressed the importance of this research for their respective missions: U.S. Department of Energy (DOE), the Centers for Disease Control and Prevention (CDC), the U.S. Department of Defense (DOD), and the National Aeronautics and Space Administration (NASA). The major components of the MPS were discussed and recent findings summarized. The importance of radiation dosimetry, an essential feature of each MPS investigation, was emphasized. RESULTS The seven components of the MPS are DOE workers, nuclear weapons test participants, nuclear power plant workers, industrial radiographers, medical radiation workers, nuclear submariners, other U.S. Navy personnel, and radium dial painters. The MPS cohorts include tens of thousands of workers with elevated intakes of alpha particle emitters for which organ-specific doses are determined. Findings to date for chronic radiation exposure suggest that leukemia risk is lower than after acute exposure; lung cancer risk is much lower and there is little difference in risks between men and women; an increase in ischemic heart disease is yet to be seen; esophageal cancer is frequently elevated but not myelodysplastic syndrome; and Parkinson's disease may be associated with radiation exposure. CONCLUSIONS The MPS has provided provocative insights into the possible range of health effects following low-level chronic radiation exposure. When the 34 MPS cohorts are completed and combined, a powerful evaluation of radiation-effects will be possible. This final article in the MPS special issue summarizes the findings to date and the possibilities for the future. A National Center for Radiation Epidemiology and Biology is envisioned.
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Affiliation(s)
- John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Brian Quinn
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Armin Ansari
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steve R. Blattnig
- National Aeronautics and Space Administration Langley Research Center, Hampton, VA, USA
| | - Emily A. Caffrey
- Radian Scientific, LLC, Huntsville, AL, and Risk Assessment Corporation, Neeses, SC, USA
| | - Sarah S. Cohen
- EpidStrategies, a division of ToxStrategies, Inc, Cary, NC, USA
| | | | - Kathryn D. Held
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Derek W. Jokisch
- Francis Marion University, Florence, SC, USA
- Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | | | - Michael T. Mumma
- Vanderbilt University School of Medicine, Nashville, TN, USA
- International Epidemiology Institute, Rockville, MD, USA
| | | | | | | | | | - Joey Y. Zhou
- United States Department of Energy, Gaithersburg, MD, USA
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12
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Abstract
The ongoing COVID-19 pandemic is of great concern for the whole world, and finding an effective treatment for the disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is, therefore, a global race. In particular, treatment options for elderly patients and patients with genetic risk factors with COVID-19-associated pneumonia are limited, and many patients die. Low-dose radiotherapy (LDRT) of lungs was used to treat pneumonia many decades ago. Since the first report on the potential efficacy of LDRT for COVID-19-associated pneumonia was published on 1 April, 2020, tens of papers have addressed the importance of this treatment. Moreover, the findings of less than 10 clinical trials conducted to date are now available. We performed a detailed search of PubMed/MEDLINE, Web of Science, Google Scholar, and Scopus and selected the nine most relevant articles. A review of these articles was conducted. The available data indicate that in oxygen-dependent elderly patients with COVID-19-associated pneumonia, whole-lung radiation at doses of 0.5–1.5 Gy can lead to accelerated recovery and progress in clinical status, encephalopathy, and radiographic consolidation without any detectable acute toxicity. Although data collected so far show that LDRT could be introduced as a treatment with promising efficacy, due to limitations such as lack of randomization in most studies, we need further large-scale randomized studies, especially for elderly patients who are at greater risk of mortality due to COVID-19. However, more preclinical work and clinical trials are needed before any clear conclusion can be made.
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13
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Shuryak I, Kachnic LA, Brenner DJ. Lung Cancer and Heart Disease Risks Associated With Low-Dose Pulmonary Radiotherapy to COVID-19 Patients With Different Background Risks. Int J Radiat Oncol Biol Phys 2021; 111:233-239. [PMID: 33930480 PMCID: PMC8078051 DOI: 10.1016/j.ijrobp.2021.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/31/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The respiratory disease COVID-19 reached global pandemic status in 2020. Excessive inflammation is believed to result in the most severe symptoms and death from this disease. Because treatment options for patients with severe COVID-19 related pulmonary symptoms remain limited, whole-lung low-dose radiation therapy is being evaluated as an anti-inflammatory modality. However, there is concern about the long-term risks associated with low-dose pulmonary irradiation. To help quantify the benefit-risk balance of low-dose radiation therapy for COVID-19, we estimated radiation-induced lifetime risks of both lung cancer and heart disease (major coronary events) for patients of different sexes, treated at ages 50 to 85, with and without other relevant risk factors (cigarette smoking and baseline heart disease risk). METHODS AND MATERIALS These estimates were generated by combining state-of-the-art radiation risk models for lung cancer and for heart disease together with background lung cancer and heart disease risks and age/sex-dependent survival probabilities for the U.S. POPULATION RESULTS Estimated absolute radiation-induced risks were generally higher for lung cancer compared with major coronary events. The highest estimated lifetime radiation-induced lung cancer risks were approximately 6% for female smokers treated between ages 50 and 60. The highest estimated radiation-induced heart disease risks were approximately 3% for males or females with high heart disease risk factors and treated between ages 50 and 60. CONCLUSIONS The estimated summed lifetime risk of lung cancer and major coronary events reached up to 9% in patients with high baseline risk factors. Predicted lung cancer and heart disease risks were lowest in older nonsmoking patients and patients with few cardiac risk factors. These long-term risk estimates, along with consideration of possible acute reactions, should be useful in assessing the benefit-risk balance for low-dose radiation therapy to treat severe COVID-19 pulmonary symptoms, and suggest that background risk factors, particularly smoking, should be taken into account in such assessments.
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Affiliation(s)
- Igor Shuryak
- Center for Radiological Research, Department of Radiation Oncology; Department of Radiation Oncology, Columbia University Irving Medical Center, New York.
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York
| | - David J Brenner
- Center for Radiological Research, Department of Radiation Oncology; Department of Radiation Oncology, Columbia University Irving Medical Center, New York
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14
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Gupta S, Ahuja R, Sharma N, Singh P, Verma S, Gupta M. Low dose lung radiotherapy for COVID-19 pneumonia: A potential treatment. Respir Med 2021; 186:106531. [PMID: 34260977 PMCID: PMC8261133 DOI: 10.1016/j.rmed.2021.106531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/20/2021] [Accepted: 07/04/2021] [Indexed: 12/31/2022]
Abstract
The covid-19 pandemic has been affecting many countries across the world and lost precious lives. Most patients suffer from respiratory disease which progresses to the severe acute respiratory syndrome, termed as SARS-CoV-2 pneumonia. A systemic inflammatory response occurs in SARS-CoV-2 pneumonia severely ill patients, The inflammation process if uncontrolled has a detrimental effect, and the release of cytokines play an important role leading to lung fibrosis. Radiation therapy used in low doses has an anti-inflammatory and immunomodulatory effect. Its low cost, wider availability, and decreased risk of acute side effects can reduce the burden on the health care system.
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Affiliation(s)
- Sweety Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India.
| | - Rachit Ahuja
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Nidhi Sharma
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Pragya Singh
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Swati Verma
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Manoj Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India
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15
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François S, Helissey C, Cavallero S, Drouet M, Libert N, Cosset JM, Deutsch E, Meziani L, Chargari C. COVID-19-Associated Pneumonia: Radiobiological Insights. Front Pharmacol 2021; 12:640040. [PMID: 34113249 PMCID: PMC8185272 DOI: 10.3389/fphar.2021.640040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
The evolution of SARS-CoV-2 pneumonia to acute respiratory distress syndrome is linked to a virus-induced “cytokine storm”, associated with systemic inflammation, coagulopathies, endothelial damage, thrombo-inflammation, immune system deregulation and disruption of angiotensin converting enzyme signaling pathways. To date, the most promising therapeutic approaches in COVID-19 pandemic are linked to the development of vaccines. However, the fight against COVID-19 pandemic in the short and mid-term cannot only rely on vaccines strategies, in particular given the growing proportion of more contagious and more lethal variants among exposed population (the English, South African and Brazilian variants). As long as collective immunity is still not acquired, some patients will have severe forms of the disease. Therapeutic perspectives also rely on the implementation of strategies for the prevention of secondary complications resulting from vascular endothelial damage and from immune system deregulation, which contributes to acute respiratory distress and potentially to long term irreversible tissue damage. While the anti-inflammatory effects of low dose irradiation have been exploited for a long time in the clinics, few recent physiopathological and experimental data suggested the possibility to modulate the inflammatory storm related to COVID-19 pulmonary infection by exposing patients to ionizing radiation at very low doses. Despite level of evidence is only preliminary, these preclinical findings open therapeutic perspectives and are discussed in this article.
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Affiliation(s)
- Sabine François
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | | | - Sophie Cavallero
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Michel Drouet
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | | | - Jean-Marc Cosset
- Centre de Radiothérapie Charlebourg/La Défense, Groupe Amethyst, La Garenne-Colombes, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Lydia Meziani
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Cyrus Chargari
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
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16
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Soyfer V, Socol Y, Bragilovski D, Corn BW. The Theoretical Value of Whole-Lung Irradiation for COVID-19 Pneumonia: A Reasonable and Safe Solution until Targeted Treatments are Developed. Radiat Res 2021; 195:474-479. [PMID: 33725726 DOI: 10.1667/rade-20-00261.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/21/2021] [Indexed: 12/15/2022]
Abstract
In this work, we considered the theoretical role of low-dose radiation therapy (approximately 0.5-1.0 Gy) in the treatment of respiratory distress syndrome associated with COVID-19 infection. Monte Carlo calculations were performed to gauge the ability to deliver low-dose radiation to the thoracic mid-plane using an orthovoltage machine. In addition, the potential harm of a single dose of 0.75 Gy (whole-lung irradiation) was assessed based on the recommendations of the BEIR-VII committee of the U.S. National Research Council. Based on the results of this work, it was determined that an orthovoltage machine (minimum 300 kVp) can be used to deliver 0.75 Gy dose to the lungs while respecting cutaneous tolerance. Using data from the BEIR-VII Committee, it is evident that the apparent benefits of such radiation treatment for patients suffering from severe manifestations of the COVID-19 infectious syndrome outweigh the potential loss of life due to radiation-induced malignancy. Although the vaccination against COVID-19 has become a reality, the spread and mortality in severely ill patients remain unacceptably high. The risk of outbreaks in the future is unknown. We suggest herein that low-dose radiotherapy at the bedside should be rigorously considered as a therapeutic option since it appears to be feasible and safe in the short and long term.
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17
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Papachristofilou A, Finazzi T, Blum A, Zehnder T, Zellweger N, Lustenberger J, Bauer T, Dott C, Avcu Y, Kohler G, Zimmermann F, Pargger H, Siegemund M. Low dose radiation therapy for severe COVID-19 pneumonia: a randomized double-blind study. Int J Radiat Oncol Biol Phys 2021:S0360-3016(21)00456-9. [PMID: 33957219 PMCID: PMC8091806 DOI: 10.1016/j.ijrobp.2021.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The morbidity and mortality of patients requiring mechanical ventilation for coronavirus disease 2019 (COVID-19) pneumonia is considerable. We studied the use of whole-lung low dose radiation therapy (LDRT) in this patient cohort. METHODS AND MATERIALS Patients admitted to the intensive care unit (ICU) and requiring mechanical ventilation for COVID-19 pneumonia were included in this randomized double-blind study. Patients were randomized to 1 Gy whole-lung LDRT or sham irradiation (sham-RT). Treatment group allocation was concealed from patients and ICU clinicians, who treated patients according to the current standard of care. Patients were followed for the primary endpoint of ventilator-free days (VFDs) at day 15 post-intervention. Secondary endpoints included overall survival, as well as changes in oxygenation and inflammatory markers. RESULTS Twenty-two patients were randomized to either whole-lung LDRT or sham-RT between November and December 2020. Patients were generally elderly and comorbid, with a median age of 75 years in both arms. No difference in 15-day VFDs was observed between groups (p = 1.00), with a median of 0 days (range, 0-9) in the LDRT arm, and 0 days (range, 0-13) in the sham-RT arm. Overall survival at 28 days was identical at 63.6% (95%CI, 40.7-99.5%) in both arms (p = 0.69). Apart from a more pronounced reduction in lymphocyte counts following LDRT (p < 0.01), analyses of secondary endpoints revealed no significant differences between the groups. CONCLUSIONS Whole-lung LDRT failed to improve clinical outcomes in critically ill patients requiring mechanical ventilation for COVID-19 pneumonia.
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Affiliation(s)
| | - Tobias Finazzi
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland.
| | - Andrea Blum
- Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Tatjana Zehnder
- Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Núria Zellweger
- Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Lustenberger
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Tristan Bauer
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Christian Dott
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Yasar Avcu
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Götz Kohler
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Frank Zimmermann
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Hans Pargger
- Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Clinic of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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18
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Miran C, Bonnet É, Allignet B, Clippe S, El Hedi Zouai M, Bosset M, Fleury B, Guy JB. [Low dose radiotherapy for COVID-19 pneumopathy: Biological rationale and literature review]. Cancer Radiother 2021; 25:494-501. [PMID: 33903009 PMCID: PMC8040522 DOI: 10.1016/j.canrad.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023]
Abstract
La pandémie de coronavirus disease 2019 (covid-19) due au severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) évolue depuis un peu plus d’un an. Si la majorité des formes est bénigne, des pneumopathies graves, voire mortelles, se développent chez certains patients plus à risque. De nombreuses pistes thérapeutiques ont été explorées avec cependant trop peu d’impact sur la mortalité. C’est dans ce contexte que Kirkby et Mackenzie ont rappelé en avril 2020 les propriétés anti-inflammatoires de la radiothérapie de faible dose (délivrant moins de 1 Gy) et son utilisation dans le traitement des pneumopathies bactériennes et virales avant l’ère des antibiotiques. En effet, de larges données in vitro et in vivo ont démontré le rationnel biologique à l’origine de la diminution de l’inflammation après une radiothérapie de faible dose dans de nombreuses pathologies. Depuis un an, trois essais cliniques de phase I/II ont été publiés ainsi qu’un essai randomisé, rapportant la faisabilité et l’amélioration clinique et biologique d’un traitement bipulmonaire par une dose 0,5 à 1 Gy. Treize autres études, dont une phase III randomisée, sont en cours dans le monde. Celles-ci pourront permettre de mieux apprécier les effets de la radiothérapie de faible dose pour la pneumonie à SARS-CoV-2. Cette revue s’attache à rappeler le rationnel biologique de l’utilisation de la radiothérapie de faible dose dans les pneumopathies, et de rapporter les résultats des essais publiés ou en cours sur son utilisation spécifique pour la pneumopathie à SARS-CoV-2.
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Affiliation(s)
- C Miran
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France; Hospices civils de Lyon, 69000 Lyon, France
| | - É Bonnet
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - B Allignet
- Hospices civils de Lyon, 69000 Lyon, France
| | - S Clippe
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - M El Hedi Zouai
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - M Bosset
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - B Fleury
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - J-B Guy
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France.
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19
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Hanna CR, Robb KA, Blyth KG, Jones RJ, Chalmers AJ. Clinician Attitudes to Using Low-Dose Radiation Therapy to Treat COVID-19 Lung Disease. Int J Radiat Oncol Biol Phys 2021; 109:886-890. [PMID: 33309910 PMCID: PMC7726525 DOI: 10.1016/j.ijrobp.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Current treatments for coronavirus disease 2019 (COVID-19) lung disease have limited efficacy. Low-dose radiation therapy (LDRT) has received both interest and criticism as a potential treatment for this condition. In this qualitative study we explored clinicians' perspectives to identify barriers to testing LDRT in clinical trials and implementing it in clinical practice. METHODS AND MATERIALS Semistructured interviews were undertaken with 6 clinicians from 3 medical disciplines. Interviews were recorded, transcribed verbatim, and analyzed thematically, using a framework approach. Common themes regarding barriers to using LDRT for COVID-19 lung disease were identified from the data. RESULTS Three categories of barriers emerged: (1) the potential to do harm to the patient, including difficulty in predicting harm and lack of existing data to inform quantification of risks; (2) the feasibility of trialing this novel treatment strategy in the clinical setting, in particular trial design and recruitment, patient selection and buy-in from relevant clinician groups; and (3) the logistics of delivering the treatment, in particular risks of transmission to other patients and resources required for patient transfer. CONCLUSIONS This study identified several barriers that may impede the evaluation and subsequent implementation of LDRT as a treatment for COVID-19 lung disease, from the perspectives of clinicians in 3 relevant specialties. By documenting and articulating these concerns, we hope to enhance discussion of why these barriers exist, and enable them to be addressed in a proactive manner to facilitate research into the potential benefits of radiation treatment for patients with COVID-19 lung disease going forward.
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Affiliation(s)
- Catherine R Hanna
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland; CRUK Clinical Trials Unit, Glasgow, Scotland.
| | - Kathryn A Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland
| | - Robert J Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland; CRUK Clinical Trials Unit, Glasgow, Scotland
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20
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Pallares R, Abergel RJ. Diagnostic, Prognostic, and Therapeutic Use of Radiopharmaceuticals in the Context of SARS-CoV-2. ACS Pharmacol Transl Sci 2021; 4:1-7. [PMID: 33615159 PMCID: PMC7839413 DOI: 10.1021/acsptsci.0c00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has devastated the healthcare systems and economies of over 200 countries in just a few months. The etiological agent of COVID-19, SARS-CoV-2, is a highly contagious virus that can be transmitted by asymptomatic and symptomatic carriers alike. While in vitro testing techniques have allowed for population-wide screening, prognostic tools are required to assess the disease severity and therapeutic response, contributing to improve the patient clinical outcomes. Moreover, no specific antiviral against COVID-19 exists at the time of publication, severely limiting treatment against the infection. Hence, there is an urgent clinical need for innovative therapeutic strategies that may contribute to manage the COVID-19 outbreak and prevent future pandemics. Herein, we critically examine recent diagnostic, prognostic, and therapeutic advancements for COVID-19 in the field of radiopharmaceuticals. First, we summarize the gold standard techniques used to diagnose COVID-19, including in vitro assays and imaging techniques, and then discuss how radionuclide-based nuclear imaging provides complementary information for prognosis and treatment management of infected patients. Second, we introduce new emerging types of radiotherapies that employ radioimmunoconjugates, which have shown selective cytotoxic response in oncological studies, and critically analyze how these compounds could be used as therapeutic agents against SARS-CoV-2. Finally, this Perspective further discusses the emerging applications of radionuclides to study the behavior of pulmonary SARS-CoV-2 aerosol particles.
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Affiliation(s)
- Roger
M. Pallares
- Chemical
Sciences Division, Lawrence Berkeley National
Laboratory, Berkeley, California 94720, United States
| | - Rebecca J. Abergel
- Chemical
Sciences Division, Lawrence Berkeley National
Laboratory, Berkeley, California 94720, United States
- Department
of Nuclear Engineering, University of California, Berkeley, California 94720, United States
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21
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Khan MK, Hess CB. A Call to Action: "Low-Dose Radiation May Help Cure COVID-19…" [Taps Mic] "…Is This Thing On?". JNCI Cancer Spectr 2021; 5:pkaa105. [PMID: 33437926 PMCID: PMC7717254 DOI: 10.1093/jncics/pkaa105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/09/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mohammad K Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Clayton B Hess
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
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22
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Low-dose radiation therapy: a treatment for pneumonia resulting from COVID-19. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920001089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Background:
The Coronavirus disease 2019 (COVID-19) is spreading rapidly throughout the world. Lung is the primary organ which the COVID-19 virus affects and leads to pneumonia, an acute respiratory distress syndrome. COVID-19 infects the lower respiratory system, and the lung’s response to this infection is recruiting macrophages and monocytes leading to inflammation, this response causes widespread damage to the lung’s airways.
Aim:
The purpose of this study is to review studies of using low-dose radiation as a treatment for the inflammation of the tissue and pneumonia resulting from COVID-19. These studies were compared with the risk of developing lung cancer during performed dose for the treatment of COVID-19 in radiation therapy.
Materials and methods:
Our study focused on in vitro, in vivo and clinical reports of using low-dose radiation for the treatment of inflammation, pneumonia and COVID-19. The risk of lung cancer resulting from suggested dose in these studies was also evaluated.
Conclusion:
From the review of articles, we have found that low-dose radiation can lead to improvement in inflammation in different line cells and animals; in addition, it has been effective in treating inflammation and pneumonia caused by COVID-19 in human up to 80%. Since suggested doses do not remarkably increase the lung cancer risk, low-dose radiation can be an adjuvant treatment for COVID-19 patients.
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23
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[Low-dose irradiation of non-malignant diseases: Did we throw the baby out with the bathwater?]. Cancer Radiother 2021; 25:279-282. [PMID: 33451911 DOI: 10.1016/j.canrad.2020.09.002] [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] [Received: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/25/2022]
Abstract
The irradiation of non-malignant diseases, essentially for anti-inflammatory purpose, have been largely proposed and performed worldwide until the 1970-80s. At that time, the better assessment of the radio-induced malignancies, essentially in children and young patients, as well as the efficacy of the new anti-inflammatory drugs (steroids and non-steroids), led to the almost disappearance of those techniques, at least in France. In contrast, our German colleagues are still going on treating about 50,000 patients per year for non-malignant (more or less severe) diseases. After a short historical overview, the present article suggests that we were possibly going too far in the rejection of those low-dose irradiations for benign lesions. The recent emergence of new preclinical data, the better understanding of the risk of radio-induced secondary tumours (almost nil in the elderly), and the severity of some situations, such as the cytokine storm of the COVID-19, should probably lead us to reconsider those low - and sometimes very low (less than 1Gy) - irradiations for well-selected indications in the elderly.
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24
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Koosha F, Pourbagheri-Sigaroodi A, Bakhshandeh M, Bashash D. Low-dose radiotherapy (LD-RT) for COVID-19-induced pneumopathy: a worth considering approach. Int J Radiat Biol 2021; 97:302-312. [PMID: 33320755 DOI: 10.1080/09553002.2021.1864049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE It seems that 2020 would be always remembered by the name of novel coronavirus (designated as SARS-CoV-2), which exerted its deteriorating effects on the health care, economy, education, and political relationships. In August 2020 more than eight hundred thousand patients lost their lives due to acute respiratory syndrome. In the limited list of therapeutic approaches, the effectiveness of low-dose radiation therapy (LD-RT) for curing inflammatory-related diseases have sparkled a light that probably this approach would bring promising advantages for COVID-19 patients. LD-RT owns its reputation from its ability to modulate the host inflammatory responses by blocking the production of pro-inflammatory cytokines and hampering the activity of leukocytes. Moreover, the cost-effective and availability of this method allow it to be applied to a large number of patients, especially those who could not receive anti-IL-6 treatments in low-income countries. But enthusiasm for applying LD-RT for the treatment of COVID-19 patients has been muted yet. CONCLUSION In this review, we take a look at LD-RT mechanisms of action in the treatment of nonmalignant diseases, and then through studying both the dark and bright sides of this approach, we provide a thorough discussion if LD-RT might be a promising therapeutic approach in COVID-19 patients.
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Affiliation(s)
- Fereshteh Koosha
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Pourbagheri-Sigaroodi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kirsch DG. Radiation Therapy as a Treatment for COVID-19? Int J Radiat Oncol Biol Phys 2020; 108:1140-1142. [PMID: 32711037 PMCID: PMC7375966 DOI: 10.1016/j.ijrobp.2020.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 01/29/2023]
Affiliation(s)
- David G Kirsch
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina; Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina.
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26
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Sanmamed N, Alcantara P, Cerezo E, Gaztañaga M, Cabello N, Gómez S, Bustos A, Doval A, Corona J, Rodriguez G, Duffort M, Ortuño F, de Castro J, Fuentes ME, Sanz A, López A, Vazquez M. Low-Dose Radiation Therapy in the Management of Coronavirus Disease 2019 (COVID-19) Pneumonia (LOWRAD-Cov19): Preliminary Report. Int J Radiat Oncol Biol Phys 2020; 109:880-885. [PMID: 33249142 PMCID: PMC7690272 DOI: 10.1016/j.ijrobp.2020.11.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Low-dose radiation therapy (LD-RT) has been shown to have an anti-inflammatory effect, and preliminary results suggest it is feasible to treat patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS We conducted a prospective, single-arm, phase 1/2 clinical trial enrolling patients aged ≥50 years, who were coronavirus disease 2019 (COVID-19) positive, at phase 2 or 3 with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Primary outcome was radiologic response using severity and extension score on baseline computed tomography (CT), at days 3 and 7 after LD-RT. Secondary outcomes were toxicity using Common Terminology Criteria for Adverse Events v.5.0, duration of hospitalization, blood work evolution, and oxygen requirements using SatO2/FiO2 index (SAFI), at days 3 and 7 after LD-RT. RESULTS Nine patients were included. Median age was 66 (interquartile range, 57-77). Severity score was stable or decreased in the third CT but was not statistically significant (P = .28); however, there were statistically significant changes in the extension score (P = .03). SAFI index significantly improved 72 hours and 1 week after LD-RT (P = .01). Inflammatory blood parameters decreased 1 week after RT compared with baseline; only lactate dehydrogenase decreased significantly (P = .04). Two patients presented grade 2 lymphopenia after RT and another (with baseline grade 3) worsened to grade 4. Overall, the median number of days of hospitalization was 59 (range, 26-151). After RT the median number of days in the hospital was 13 (range, 4-77). With a median follow-up after RT of 112 days (range, 105-150), 7 patients were discharged and 2 patients died, 1 due to sepsis and the other with severe baseline chronic obstructive pulmonary disease from COVID-19 pneumonia. CONCLUSIONS Our preliminary results show that LD-RT was a feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.
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Affiliation(s)
- Noelia Sanmamed
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain.
| | - Pino Alcantara
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Elena Cerezo
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Miren Gaztañaga
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Noemi Cabello
- Internal Medicine Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Sara Gómez
- Radiology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Ana Bustos
- Radiology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Anxela Doval
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Juan Corona
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Gabriel Rodriguez
- Medical Physics Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Mercedes Duffort
- Internal Medicine Department, Infanta Leonor Hospital, Madrid, Spain
| | | | | | - Manuel Enrique Fuentes
- Preventive Department, Clinico San Carlos Hospital, Madrid, Spain; Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - Alvaro Sanz
- Medical Oncology Department, Rio Hortega Hospital, Valladolid, Spain
| | - Amanda López
- Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - Manuel Vazquez
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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27
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Arruda GV, Weber RRDS, Bruno AC, Pavoni JF. The risk of induced cancer and ischemic heart disease following low dose lung irradiation for COVID-19: estimation based on a virtual case. Int J Radiat Biol 2020; 97:120-125. [PMID: 33164596 PMCID: PMC7682378 DOI: 10.1080/09553002.2021.1846818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Recently, low dose radiotherapy delivered to the whole lung has been proposed as treatment for the pneumonia due to COVID-19. Although there is biological plausibility for its use, the evidence supporting its effectiveness is scarce, and the risks associated with it may be significant. Thus, based on a virtual case simulation, we estimated the risks of radiation-induced cancer (RIC) and cardiac disease. Methods Lifetime attributable risks (LAR) of RIC were calculated for the lung, liver, esophagus, and breast of female patients. The cardiovascular risk of exposure-induced death (REID) due to ischemic heart disease was also calculated. The doses received by the organs involved in the treatment were obtained from a simulation of conformal radiotherapy (RT) treatment, delivering a dose of 0.5 Gy–1.5 Gy to the lungs. We considered a LAR and REID <1% as acceptable, 1–2% cautionary, and >2% unacceptable. Results The lung was at the highest risk for RIC (absolute LAR below 5200 cases/100,000 and 2250 cases/100,000 for women and men, respectively). For women, the breast had the second-highest LAR, especially for young women. The liver and esophagus had LARs below 700/100,000 for both sexes, with a higher incidence of esophageal cancer in women and liver cancer in men. Regarding the LAR cutoff, we observed an unacceptable or cautionary LAR for lung cancer in all women and men <60 years with an RT dose >1 Gy. LAR for lung cancer with an RT dose of 1 Gy was cautionary for women >60 years of age and men <40 years of age. No LAR estimation was unacceptable for the RT dose ≤0.7 Gy in all groups irrespective of sex or age at exposure. Only 0.5 Gy had an acceptable REID. Conclusions A RT dose ≤0.5 Gy provides an acceptable LAR estimate (≤1%) for RIC and REID, irrespective of sex and age. The current ongoing trials should initially use doses ≤0.5 Gy to maintain the risks at an acceptable level and include only patients who fail or do not have any other treatment option.
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Affiliation(s)
- Gustavo Viani Arruda
- Radiotherapy Department, Ribeirão Preto Medical School Hospital and Clinics, University of São Paulo, São Paulo, Brazil
| | - Raissa Renata Dos Santos Weber
- Department of Physics, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alexandre Colello Bruno
- Radiotherapy Department, Ribeirão Preto Medical School Hospital and Clinics, University of São Paulo, São Paulo, Brazil
| | - Juliana Fernandes Pavoni
- Radiotherapy Department, Ribeirão Preto Medical School Hospital and Clinics, University of São Paulo, São Paulo, Brazil.,Department of Physics, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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28
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Prasanna PG, Woloschak GE, DiCarlo AL, Buchsbaum JC, Schaue D, Chakravarti A, Cucinotta FA, Formenti SC, Guha C, Hu DJ, Khan MK, Kirsch DG, Krishnan S, Leitner WW, Marples B, McBride W, Mehta MP, Rafii S, Sharon E, Sullivan JM, Weichselbaum RR, Ahmed MM, Vikram B, Coleman CN, Held KD. Low-Dose Radiation Therapy (LDRT) for COVID-19: Benefits or Risks? Radiat Res 2020; 194:452-464. [PMID: 33045077 PMCID: PMC8009137 DOI: 10.1667/rade-20-00211.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022]
Abstract
The limited impact of treatments for COVID-19 has stimulated several phase 1 clinical trials of whole-lung low-dose radiation therapy (LDRT; 0.3-1.5 Gy) that are now progressing to phase 2 randomized trials worldwide. This novel but unconventional use of radiation to treat COVID-19 prompted the National Cancer Institute, National Council on Radiation Protection and Measurements and National Institute of Allergy and Infectious Diseases to convene a workshop involving a diverse group of experts in radiation oncology, radiobiology, virology, immunology, radiation protection and public health policy. The workshop was held to discuss the mechanistic underpinnings, rationale, and preclinical and emerging clinical studies, and to develop a general framework for use in clinical studies. Without refuting or endorsing LDRT as a treatment for COVID-19, the purpose of the workshop and this review is to provide guidance to clinicians and researchers who plan to conduct preclinical and clinical studies, given the limited available evidence on its safety and efficacy.
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Affiliation(s)
| | | | | | | | | | - Arnab Chakravarti
- Ohio State University, James Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | - Dale J. Hu
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Mohammad K. Khan
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA
| | | | | | | | - Brian Marples
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | - Ralph R. Weichselbaum
- University of Chicago Medicine and Ludwig Center for Metastasis Research, Chicago, IL
| | | | | | | | - Kathryn D. Held
- National Council on Radiation Protection and Measurements, Bethesda, MD and Massachusetts General Hospital/Harvard Medical School, Boston, MA
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29
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Oberemok VV, Laikova KV, Yurchenko KA, Fomochkina II, Kubyshkin AV. SARS-CoV-2 will continue to circulate in the human population: no worries with state-of-the-art research and dependably useful results. Inflamm Res 2020; 70:77-78. [PMID: 33123787 PMCID: PMC7595875 DOI: 10.1007/s00011-020-01417-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/01/2022] Open
Abstract
This short article provides additional justification for our understanding of the virus-host relationship in the population. Some new data are presented concerning viral structure/behavior and a critical assessment on the possibilities of using new approaches for the treatment of patients with COVID-19.
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Affiliation(s)
| | - Kateryna V Laikova
- V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation
| | | | - Irina I Fomochkina
- V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation
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30
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Verma A, Adhikary A, Woloschak G, Dwarakanath BS, Papineni RVL. A combinatorial approach of a polypharmacological adjuvant 2-deoxy-D-glucose with low dose radiation therapy to quell the cytokine storm in COVID-19 management. Int J Radiat Biol 2020; 96:1323-1328. [PMID: 32910699 DOI: 10.1080/09553002.2020.1818865] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a pandemic disease and is the major cause of deaths worldwide. The clinical complexities (inflammation, cytokine storm, and multi-organ dysfunction) associated with COVID-19 poses constraints to effective management of critically ill COVID-19 patients. Low dose radiation therapy (LDRT) has been evaluated as a potential therapeutic modality for COVID-19 pneumonia. However, due to heterogeneity in disease manifestation and inter-individual variations, effective planning for LDRT is limited for this large-scale event. 2-deoxy-D-glucose (2-DG) has emerged as a polypharmacological agent for COVID-19 treatment due to its effects on the glycolytic pathway, anti-inflammatory action, and interaction with viral proteins. We suggest that 2-DG will be a potential adjuvant to enhance the efficacy of LDRT in the treatment of COVID-19 pneumonia. Withal, azido analog of 2-DG, 2-azido-2-DG can produce rapid catastrophic oxidative stress and quell the cytokine storm in critically ill COVID-19 patients.
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Affiliation(s)
| | | | - Gayle Woloschak
- Department of Radiobiology, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Bilikere S Dwarakanath
- Department of Research and Development, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China
| | - Rao V L Papineni
- Department of Surgery, University of Kansas Medical Center (Adjunct), and PACT & Health LLC, Branford, CT, USA
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31
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The immuno-oncological challenge of COVID-19. ACTA ACUST UNITED AC 2020; 1:946-964. [DOI: 10.1038/s43018-020-00122-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
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32
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Fuller CD, van Dijk LV, Thompson RF, Scott JG, Ludmir EB, Thomas CR. Meeting the Challenge of Scientific Dissemination in the Era of COVID-19: Toward a Modular Approach to Knowledge-Sharing for Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 108:496-505. [PMID: 32890543 PMCID: PMC7462881 DOI: 10.1016/j.ijrobp.2020.06.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas; Department of Radiation Medicine, Oregon Health & Science University, Oregon.
| | - Lisanne V van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas; Department of Radiation Oncology, University Medical Center- Groningen, Groningen, Netherlands
| | - Reid F Thompson
- Department of Radiation Medicine, Oregon Health & Science University, Oregon
| | - Jacob G Scott
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Oregon
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33
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Pandey BN. Low-dose radiation therapy for coronavirus disease-2019 pneumonia: Is it time to look beyond apprehensions? Ann Thorac Med 2020; 15:199-207. [PMID: 33381234 PMCID: PMC7720738 DOI: 10.4103/atm.atm_433_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) has become a global health crisis. Mortality associated with COVID-19 is characterized mainly by acute respiratory distress syndrome (ARDS), sepsis, pneumonia, and respiratory failure. The pathogenesis of the disease is known to be associated with pro-inflammatory processes after virus infection. Hence, various therapeutic strategies are being developed to control the inflammation and cytokine storm in COVID-19 patients. Recently, low-dose radiation therapy (LDRT) has been suggested for the treatment of pneumonia/ADRS in COVID-19 patients through irradiation of lungs by gamma/X-ray. In this direction, a few clinical trials have also been initiated. However, a few recent publications have raised some concerns regarding LDRT, especially about possibilities of activation/aggressiveness of virus (severe acute respiratory syndrome coronavirus 2 in case of COVID-19), lung injury and risk of second cancer after low-dose therapy. The present manuscript is an attempt to analyze these apprehensions based on cited references and other available literature, including some from our laboratory. At this point, LDRT may be not the first line of therapy. However, based on existing anti-inflammatory evidence of LDRT, it needs encouragement as an adjuvant therapy and for more multi-centric clinical trials. In addition, it would be worth combining LDRT with other anti-inflammatory therapies, which would open avenues for multi-modal therapy of pneumonia/ARDS in COVID-19 patients. The mode of irradiation (local lung irradiation or whole-body irradiation) and the window period after infection of the virus, need to be optimized using suitable animal studies for effective clinical outcomes of LDRT. However, considering ample evidence, it is time to look beyond the apprehensions if a low dose of radiation could be exploited for better management of COVID-19 patients.
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Affiliation(s)
- Badri Narain Pandey
- Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
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34
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Little MP, Zhang W, van Dusen R, Hamada N. Pneumonia After Bacterial or Viral Infection Preceded or Followed by Radiation Exposure: A Reanalysis of Older Radiobiologic Data and Implications for Low-Dose Radiation Therapy for Coronavirus Disease 2019 Pneumonia. Int J Radiat Oncol Biol Phys 2020; 109:849-858. [PMID: 33011212 PMCID: PMC7527825 DOI: 10.1016/j.ijrobp.2020.09.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 12/02/2022]
Abstract
Purpose Currently, there are about 15 ongoing clinical studies on low dose radiation therapy for Coronavirus Disease 2019 pneumonia. One of the underlying assumptions is that irradiation of 0.5 to 1.5 Gy is effective at ameliorating viral pneumonia. We aimed to reanalyze all available experimental radiobiologic data to assess evidence for such amelioration. Methods and Materials With standard statistical survival models, and based on a systematic literature review, we reanalyzed 13 radiobiologic animal data sets published in 1937 to 1973 in which animals (guinea pigs/dogs/cats/rats/mice) received radiation before or after bacterial or viral inoculation, and assessing various health endpoints (mortality/pneumonia morbidity). In most data sets absorbed doses did not exceed 7 Gy. Results For 6 studies evaluating postinoculation radiation exposure (more relevant to low dose radiation therapy for Coronavirus Disease 2019 pneumonia) the results are heterogeneous, with one study showing a significant increase (P < .001) and another showing a significant decrease (P < .001) in mortality associated with radiation exposure. Among the remaining 4 studies, mortality risk was nonsignificantly increased in 2 studies and nonsignificantly decreased in 2 others (P > .05). For preinoculation exposure the results are also heterogeneous, with 6 (of 8) data sets showing a significant increase (P < .01) in mortality risk associated with radiation exposure and the other 2 showing a significant decrease (P < .05) in mortality or pneumonitis morbidity risk. Conclusions These data do not provide support for reductions in morbidity or mortality associated with postinfection radiation exposure. For preinfection radiation exposure the inconsistency of direction of effect is difficult to interpret. One must be cautious about adducing evidence from such published reports of old animal data sets.
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Affiliation(s)
- Mark P Little
- Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland.
| | - Wei Zhang
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, Didcot, United Kingdom
| | - Roy van Dusen
- Information Management Services, Silver Spring, Maryland
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry, Tokyo, Japan
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35
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Ghahramani-Asl R, Porouhan P, Mehrpouyan M, Welsh JS, Calabrese EJ, Kapoor R, Dhawan G, Javadinia SA. Feasibility of Treatment Planning System in Localizing the COVID-19 Pneumonia Lesions and Evaluation of Volume Indices of Lung Involvement. Dose Response 2020; 18:1559325820962600. [PMID: 33088245 PMCID: PMC7545774 DOI: 10.1177/1559325820962600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
Background and purpose To assess the feasibility of a treatment planning system in localizing, contouring, and targeting lung lesions along with an evaluation of volume indices of lung involvement in patients with COVID-19 pneumonia. Methods We evaluated 10 patients with PCR-confirmed COVID-19 pneumonia. The CT images were imported into the ISOgray® treatment planning system to anatomically define and contour the volumes of the pulmonary lesions, the lungs, and other nearby organs. Results The ratio of lung lesion volume to lung volume in this study was 0.11 ± 0.13 (11.13%). The highest mean biosynthesis ratio of lung lesions was 0.36. The ratio of lesion volume in the left lung of patients with the highest volume of involvement, was 0.44, and the ratio of lesion volume in the right lung of these patients was 0.27 (approximately 1.5 times more in the left lung than the right lung). On average, CTDIvol and DLP for all patients studied in our study were 11.22 ± 2.47 mGy and 354.20 ± 65.11 mGy.cm. Conclusion We reported the feasibility of using a treatment planning system in localizing COVID-19 pulmonary lesions and its validity in the volumetric assessment of infected lung regions.
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Affiliation(s)
- Ruhollah Ghahramani-Asl
- Department of Medical Physics and Radiation Sciences, Faculty of Paramedicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Pejman Porouhan
- Department of Radiation Oncology, Vasei Educational Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Mehrpouyan
- Department of Medical Physics and Radiation Sciences, Faculty of Paramedicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - James S Welsh
- Loyola University Chicago, Edward Hines Jr., VA Hospital, Stritch School of Medicine, Department of Radiation Oncology, Maywood, IL, USA
| | - Edward J Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Rachna Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | | | - Seyed Alireza Javadinia
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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36
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Skinner HD. Mining the past to treat the present, ever mindful of the future: Low-dose radiotherapy and COVID-19 pneumonia. Cancer 2020; 126:5017-5021. [PMID: 32985700 PMCID: PMC7536983 DOI: 10.1002/cncr.33201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
This editorial discusses an interim analysis of the clinical trial by Hess et al. The trial examines the use of low‐dose radiotherapy in the treatment of patients with coronavirus disease 2019 (COVID‐19) pneumonia.
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Affiliation(s)
- Heath D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
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37
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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]
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38
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Hadjiyiannakis D, Dimitroyannis D, Eastlake L, Peedell C, Tripathi L, Simcock R, Vyas A, Deutsch E, Chalmers AJ. Personal View: Low-Dose Lung Radiotherapy Should be Evaluated as a Treatment for Severe COVID-19 Lung Disease. Clin Oncol (R Coll Radiol) 2020; 33:e64-e68. [PMID: 32829986 PMCID: PMC7427522 DOI: 10.1016/j.clon.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- D Hadjiyiannakis
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK; NIHR Lancashire Clinical Research Facility, Preston, UK
| | | | - L Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, UK.
| | - C Peedell
- James Cook University Hospital, Middlesbrough, UK
| | - L Tripathi
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK; NIHR Lancashire Clinical Research Facility, Preston, UK
| | - R Simcock
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Vyas
- Lancashire Teaching Hospitals, NHS Foundation Trust, Preston, UK
| | - E Deutsch
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris, Villejuif, France
| | - A J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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39
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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
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40
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Tharmalingam H, Díez P, Tsang Y, Hawksley A, Conibear J, Thiruthaneeswaran N. Personal View: Low-dose Lung Radiotherapy for COVID-19 Pneumonia - The Atypical Science and the Unknown Collateral Consequence. Clin Oncol (R Coll Radiol) 2020; 32:497-500. [PMID: 32536559 PMCID: PMC7284241 DOI: 10.1016/j.clon.2020.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Affiliation(s)
- H Tharmalingam
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK.
| | - P Díez
- Department of Radiotherapy Physics, Mount Vernon Cancer Centre, Northwood, UK
| | - Y Tsang
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - A Hawksley
- Department of Acute Medicine, University Hospital Lewisham, London, UK
| | - J Conibear
- Department of Clinical Oncology, St Bartholomew's Hospital, London, UK
| | - N Thiruthaneeswaran
- Division of Cancer Sciences, The University of Manchester, Manchester, UK; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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41
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Kirsch DG, Diehn M, Cucinotta FA, Weichselbaum R. Response Letter: Radiation therapy for COVID-19 pneumopathy. Radiother Oncol 2020; 149:238-239. [PMID: 32505722 PMCID: PMC7272168 DOI: 10.1016/j.radonc.2020.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Affiliation(s)
- David G Kirsch
- Department of Radiation Oncology, Duke University Medical Center, Durham, USA; Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, USA.
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, USA; Stanford Cancer Institute, Stanford University, Stanford, USA
| | - Francis A Cucinotta
- Department of Health Physics and Diagnostic Sciences, University of Nevada Las Vegas, USA
| | - Ralph Weichselbaum
- Department of Radiation and Cellular Oncology, The University of Chicago, USA
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42
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Trott KR, Zschaeck S, Beck M. Radiation therapy for COVID-19 pneumopathy. Radiother Oncol 2020; 147:210-211. [PMID: 32437821 PMCID: PMC7206436 DOI: 10.1016/j.radonc.2020.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sebastian Zschaeck
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Marcus Beck
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Berlin, Germany
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