Whole-lung Low Dose Irradiation for SARS-Cov2 Induced Pneumonia in the Geriatric Population: An Old Effective Treatment for a New Disease? Recommendation of the International Geriatric Radiotherapy Group

Abstract

A cytokine storm induced by SARS-Cov2 may produce pneumonitis which may be fatal for older patients with underlying lung disease. Hyper-elevation of Interleukin1 (IL-1), Tumor necrosis factor-1alfa (TNF-1 alfa), and Interleukin 6 (IL-6) produced by inflammatory macrophage M1 may damage the lung alveoli leading to severe pneumonitis, decreased oxygenation, and potential death despite artificial ventilation. Older patients may not be suitable candidates for pharmaceutical intervention targeting IL-1/6 blockade or artificial ventilation. Low dose total lung (LDTL) irradiation at a single dose of 50 cGy may stop this cytokine cascade, thus preventing, and/or reversing normal organs damage. This therapy has been proven in the past to be effective against pneumonitis of diverse etiology and could be used to prevent death of older infected patients. Thus, LDRT radiotherapy may be a cost-effective treatment for this frail patient population whom radiation-induced malignancy is not a concern because of their advanced age. This hypothesis should be tested in future prospective trials.

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“…However, after the onset of effective antimicrobial agents, the use of IR in the treatment of patients has been discontinued and the involved mechanism remained unknown. Following the excess death toll related to the COVID-19 pandemic, some radiation oncologists suggested the use of low doses of RT to treat COVID-19 patients suffering from ARDS [25][26][27][28][29], even if this raised some criticism, [30][31][32][33] given the uncertainties regarding a potential viral flare-up or an increase in lung tissue damage [34]. In the absence of preclinical data, the scientific community is puzzled between the risks associated with a whole lung irradiation (acute worsening of the patients, and the immediate intrinsic risk of ARDS) [34].…”

Low doses of radiation increase the immunosuppressive profile of lung macrophages during viral infection and pneumonia

“…However, after the onset of effective antimicrobial agents, the use of IR in the treatment of patients has been discontinued and the involved mechanism remained unknown. Following the excess death toll related to the COVID-19 pandemic, some radiation oncologists suggested the use of low doses of RT to treat COVID-19 + patients suffering from ARDS (24)(25)(26)(27)(28), even if this raised some criticism, (29)(30)(31)(32) given the uncertainties regarding a potential viral flare-up or an increase in lung tissue damage. In the absence of preclinical data, the scientific community is puzzled between the risks associated with a whole lung irradiation (acute worsening of the patients, and the immediate intrinsic risk of ARDS).…”

Low dose whole Lung Therapy for patients with SARS-CoV-2 disease (COVID-19) Pneumonitis

“…А ведь лучевая терапия демонстрирует не только снижение показателей нахождения пациента в больнице, но и удешевление процесса лечения пациентов. Если такой вид лечения, как лучевая терапия, продемонстрирует сокращение времени госпитализации у пациентов с коронавирусной пневмонией и спасет жизнь пациентам, то это будет воспринято с энтузиазмом медицинским сообществом во всем мире [47]. Таким образом, международное исследовательское сотрудничество в изучении пользы и эффективности лучевой терапии позволит не только исследовать биологические эффекты лучевой терапии, но и повлиять на уровень смертности среди пациентов с пневмонией, вызванной COVID-19.…”