Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
STUK-Radiation and Nuclear Safety Authority, Helsinki, Finland.
Int J Radiat Biol. 2020 Oct;96(10):1228-1235. doi: 10.1080/09553002.2020.1786609. Epub 2020 Jul 13.
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.
自 2020 年 4 月初以来，对于是否将电离辐射用于治疗 2019 年冠状病毒病（COVID-19）患者的致命性肺炎，一直存在激烈的争论。截至 2020 年 5 月 20 日，至少有 12 篇相关论文发表。临床试验中提出的辐射剂量为单次剂量（0.1-1Gy）或两次剂量（先给予几毫戈瑞，然后再给予 0.1-0.25Gy，涉及可能的适应性反应，或者在 2-3 天内分两次给予 1-1.5Gy）。这种所谓的低剂量放射治疗（LDRT）的科学依据有两点（请注意，在辐射防护领域，只有低于 0.1Gy 的剂量才被认为是低剂量，但在这里我们遵循放射肿瘤学领域的惯用术语）。首先，在抗生素前时代，人类病例系列和啮齿动物模型中关于病毒或细菌性肺炎的潜在阳性观察结果。其次，LDRT 的潜在抗炎特性，当 LDRT 局部应用于亚急性退行性关节疾病时，主要在德国，已经观察到这种特性。然而，作为支持证据引用的人体和动物研究存在显著局限性，并且 LDRT 是否在发炎的肺部产生抗炎作用或加剧正在进行的 COVID-19 损伤仍不清楚。因此，我们的结论是，现有的科学证据并不支持对 COVID-19 肺炎进行 LDRT 的临床试验，因为 LDRT 未知的益处和已知的放射性癌症和循环系统疾病的死亡率风险。尽管这些提议存在重大不确定性，但一些临床试验正在进行中并计划进行。本文概述了围绕 LDRT 治疗 COVID-19 肺炎的当前情况。
