Subject(s)
Betacoronavirus , Coronavirus Infections/radiotherapy , Pandemics , Pneumonia, Viral/radiotherapy , Respiratory Insufficiency/prevention & control , Appointments and Schedules , COVID-19 , Clinical Trial Protocols as Topic , Coronavirus Infections/complications , Coronavirus Infections/immunology , Cytokine Release Syndrome/etiology , Disease Progression , Humans , Immune System/radiation effects , Inflammation/radiotherapy , Models, Immunological , Pneumonia/immunology , Pneumonia/radiotherapy , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Radiotherapy/adverse effects , Radiotherapy Dosage , Risk Factors , SARS-CoV-2ABSTRACT
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.