Flying by the seat of our pants: is low dose radiation therapy for COVID-19 an option?

Schaue, Dörthe; McBride, William H.

doi:10.1080/09553002.2020.1767314

Cited by 14 publications

(17 citation statements)

References 40 publications

(36 reference statements)

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“…An update since mid-April 2020: relevant new papers and ongoing clinical trials From 20 April through 20 May 2020, ten papers on LDRT for COVID-19 pneumonia appeared (Chakrabarti and Verma 2020;Dhawan et al 2020;Kefayat and Ghahremani 2020;Kirsch et al 2020;Lara et al 2020;R€ odel et al 2020;Salomaa et al 2020;Schaue and McBride 2020;Trott et al 2020;Kirkby and Mackenzie 2020b).…”

Section: Introductionmentioning

confidence: 99%

“…once hypoxia or ARDS develops in COVID-19 patients). Likewise, Schaue and McBride (2020) also considered that the chances of LDRT being effective in counteracting even a minor cytokine release storm in advanced stage disease would seem slim at best. Trott et al (2020) considered biological studies in vitro that concentrate on specific pathways in the complex network of molecular signaling leading from trigger to overt disease to be most relevant, as we previously proposed the use of pulmonary microvascular endothelial cells (PMEC) to this end (Salomaa et al 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Since then, LDRT has been increasingly restricted to painful degenerative joint diseases (e.g. osteoarthritis) in the elderly where non-steroidal antiinflammatory drugs or corticosteroids are not an option (Schaue and McBride 2020). However, a number of doubleblinded studies on painful degenerative skeletal disorders have not shown a significantly higher response for the LDRT group compared with the placebo group (Seegenschmiedt et al 2015).…”

Section: Introductionmentioning

confidence: 99%

“…The suggested underlying mechanism for a beneficial effect was enhanced apoptosis, but enhanced apoptosis of normal cells should in fact culminate in increased normal tissue toxicity. However, as noted by Kirsch et al (2020) and Schaue and McBride (2020), the consequences of a potential infection of staff and equipment in a repurposed radiation oncology unit were not taken into account. Schaue and McBride (2020) cautioned that it is premature to suggest that LDRT would be superior to any of the drugs currently under trials, and until information from drug trials is available, it may be unethical to proceed with human trials given the potential adverse health effects consequent to radiation exposure.…”

Section: Introductionmentioning

confidence: 99%

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Is there any supportive evidence for low dose radiotherapy for COVID-19 pneumonia?

Salomaa

Bouffler

Atkinson

et al. 2020

International Journal of Radiation Biology

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Since early April 2020, there has been intense debate over proposed clinical use of ionizing radiation to treat life-threatening pneumonia in Coronavirus Disease 2019 (COVID-19) patients. At least twelve relevant papers appeared by 20 May 2020. The radiation dose proposed for clinical trials are a single dose (0.1-1 Gy) or two doses (a few mGy followed by 0.1-0.25 Gy involving a putative adaptive response, or 1-1.5 Gy in two fractions 2-3 days apart). The scientific rationale for such proposed so-called low dose radiotherapy (LDRT) is twofold (note that only doses below 0.1 Gy are considered as low doses in the field of radiation protection, but here we follow the term as conventionally used in the field of radiation oncology). Firstly, the potentially positive observations in human case series and biological studies in rodent models on viral or bacterial pneumonia that were conducted in the pre-antibiotic era. Secondly, the potential anti-inflammatory properties of LDRT, which have been seen when LDRT is applied locally to subacute degenerative joint diseases, mainly in Germany. However, the human and animal studies cited as supportive evidence have significant limitations, and whether LDRT produces anti-inflammatory effects in the inflamed lung or exacerbates ongoing COVID-19 damage remains unclear. Therefore, we conclude that the available scientific evidence does not justify clinical trials of LDRT for COVID-19 pneumonia, with unknown benefit and known mortality risks from radiogenic cancer and circulatory disease. Despite the significant uncertainties in these proposals, some clinical trials are ongoing and planned. This paper gives an overview of current situations surrounding LDRT for COVID-19 pneumonia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is there any supportive evidence for low dose radiotherapy for COVID-19 pneumonia?

Salomaa

Bouffler

Atkinson

et al. 2020

International Journal of Radiation Biology

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“…Another recent editorial by Schaue and McBride (2020) summarizes the questions that would need to be answered on the mechanisms and the main driver of COVID-19 pneumonia, as well as of possible LDRT-induced mechanisms of clinical value. It suggests that only a fraction of the COVID-19 pneumonia patients are likely to respond favorably to LDRT, and that their early identification, possibly through a clinical profile, is needed before using LDRT.…”

mentioning

confidence: 99%

Radiotherapy in the fight against pneumonia associated with SARS-CoV-2

Hertzog¹,

Bicheru²

2020

International Journal of Radiation Biology

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Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

Piras¹,

Venuti

D’Aviero³

et al. 2022

Clin Transl Imaging

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Introduction Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role. Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians. Methods A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was “Covid AND Radiotherapy” and only original articles in the English language were considered. Results A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results. Discussion RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period.

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Flying by the seat of our pants: is low dose radiation therapy for COVID-19 an option?

Cited by 14 publications

References 40 publications

Is there any supportive evidence for low dose radiotherapy for COVID-19 pneumonia?

Is there any supportive evidence for low dose radiotherapy for COVID-19 pneumonia?

Radiotherapy in the fight against pneumonia associated with SARS-CoV-2

Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

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