ABSTRACT
Patients (around 40-50%) who were infected by SARS-CoV-2 develop a condition called as long-COVID-19 that lasted longer than the infection. One of the complications of post-COVID-19 (PC) is pulmonary fibrosis. T he purpose of this study was to identify blood biomarkers to predict PC patients undergoing pulmonary fibrosis. We analysed blood samples of healthy, anti-SARS-CoV-2 vaccinated subjects and PC patients, who were stratified according to the severity of the disease and chest computed tomography (CT) scan data that revealed fibrotic or non-fibrotic areas. PC patients had higher levels of the inflammatory C reactive protein (CRP), complement complex C5b-9, LDH, but not IL-6, independently of the severity of the disease and lung fibrotic areas. Interestingly, PC patients who presented signs of lung fibrosis were characterized by higher plasma levels of IL-1alpha, CXCL-10, TGF-beta, but not of IFN-beta, compared to healthy and vaccinated (VAX) subjects. In particular, 19 out of 23 (82.6%) severe PC and 8 out of 29 (27.6%) moderate PC patients presented signs of lung fibrosis, associated to lower levels of IFN-beta but higher IL-1alpha and TGF-beta. Instead, t he levels of IFN-beta were associated to the capability of the patient to respond to the infection without signs of lung fibrosis, implying a beneficial role of this cytokine. In conclusion, we found that higher plasma levels of IL-1alpha and TGF-beta, but not of IFN-beta, could predict an increased relative risk (RR=2.8) of lung fibrosislike changes in PC patients.
ABSTRACT
Stereotactic Body Radiation Therapy (SBRT) is a standard of care for many localizations but the question of the optimal fractionation remains a matter of concern. If single fraction sessions are routinely used for intracranial targets, their utilization for mobile extracranial lesions is a source of debate and apprehension. Single session treatments improve patient comfort, provide a medico-economic benefit, and have proven useful in the context of the SARS-CoV 2 pandemic. However, both technical and radiobiological uncertainties remain. Experience from intracranial radiosurgery has shown that the size of the target, its proximity to organs at risk, tumor histology, and the volume of normal tissue irradiated are all determining factors in the choice of fractionation. The literature on the use of single fraction for extracranial sites is still scarce. Only primary and secondary pulmonary tumors have been evaluated in prospective randomized trials, allowing the integration of these fractionation schemes in daily practice, for highly selected cases and in trained teams. The level of evidence for the other organs is mainly based on dose escalation or retrospective trials and calls for caution, with further studies being needed before routine use in clinical practice.