Center for Radiological Research, Department of Radiation Oncology; Department of Radiation Oncology, Columbia University Irving Medical Center, New York.
Department of Radiation Oncology, Columbia University Irving Medical Center, New York.
Int J Radiat Oncol Biol Phys. 2021 Sep 1;111(1):233-239. doi: 10.1016/j.ijrobp.2021.04.018. Epub 2021 Apr 27.
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).
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.
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.
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.
2020 年，呼吸道疾病 COVID-19 达到全球大流行状态。据信，过度炎症会导致这种疾病出现最严重的症状和死亡。由于治疗严重 COVID-19 相关肺部症状的选择有限，因此正在评估全肺低剂量放射治疗作为一种抗炎方式。然而，人们对与低剂量肺照射相关的长期风险存在担忧。为了帮助量化 COVID-19 低剂量放射治疗的获益风险平衡，我们估计了不同性别、50 至 85 岁接受治疗且具有和不具有其他相关风险因素（吸烟和基线心脏病风险）的患者接受低剂量放射治疗后发生肺癌和心脏病（主要冠心病事件）的终生风险。
这些估计是通过将肺癌和心脏病的最新放射风险模型与背景肺癌和心脏病风险以及美国的年龄/性别相关的生存概率相结合来生成的。
与主要冠心病事件相比，估计的肺癌的绝对放射诱发风险通常更高。女性吸烟者在 50 至 60 岁之间接受治疗时，估计的终生辐射诱发肺癌风险最高约为 6%。对于基线心脏病风险较高且在 50 至 60 岁之间接受治疗的男性或女性，估计的最高辐射诱发心脏病风险约为 3%。
在基线风险因素较高的患者中，估计的终生肺癌和主要冠心病事件的总和风险高达 9%。在年龄较大的不吸烟者和心脏病风险因素较少的患者中，预测的肺癌和心脏病风险最低。这些长期风险估计值，以及对可能的急性反应的考虑，应该有助于评估低剂量放射治疗治疗严重 COVID-19 肺部症状的获益风险平衡，并表明在这种评估中应考虑背景风险因素，特别是吸烟。
