ABSTRACT
The COVID-19 pandemic has been going on for more than a year. COVID-19 causes asymptomatic infection, severe infection, until death. Diagnosis of COVID-19 infection is made by blood tests, antigen swabs, PCR, as well as radiology and CT-scan examinations. Severe COVID-19 infection shows similar symptoms to acute radiation injury. The paper aims to describe the similarity of severe infection COVID-19 and syndrome of acute radiation injury. This paper is a literature review. Literature was searched in the Science Direct and PubMed databases. The keywords were severe COVID-19 infection, acute radiation syndrome, similarity. The similarities between the pathophysiology of severe COVID-19 infection and acute radiation injury are cytokine storms. Symptoms of severe COVID-19 infection are acute respiratory distress syndrome (ARDS), hypoxia, and damage to the cardiovascular system. Researchers are trying to look for symptoms similar to this severe COVID-19 infection so they can find better prevention and therapeutic measures. Study of biological radiation has shown complex organ failure after exposure to high doses of radiation. This condition is called the acute radiation syndrome (ARS). Severe inflammation accompanied by cytokine storms causes severe symptoms of COVID-19 or ARS infection. ARS is diagnosed with a variety of biomarkers of radiation exposure. The similarity of symptoms and pathophysiology may be used to plan better treatment for patients with severe COVID-19 infection in the future. The treatment would be the same. © 2022 Author(s).
ABSTRACT
Purpose: Breast-conserving surgery followed by several weeks of adjuvant radiotherapy is the current standard of care for low-risk breast cancer. A novel approach using single-fraction neoadjuvant radiotherapy is under study. We sought to investigate the rate of pathologic response, toxicities and cosmetic results related to this new treatment strategy. Material(s) and Method(s): Women 65 years of age or older with a new diagnosis of Stage I unifocal luminal A breast cancer were eligible for inclusion in this Phase I prospective trial. A single 20 Gy dose of radiotherapy to the breast tumour was given, followed by breast-conserving surgery three months later. The primary endpoint was the pathologic response rate assessed by microscopic evaluation using the Miller-Payne system. The secondary endpoints were the incidence of radiation toxicity and the cosmetic results, graded according to the Common Terminology Criteria for Adverse Events and the European Organisation for Research and Treatment of Cancer Cosmetic Rating System, respectively. Secondary outcomes were assessed at 6 weeks, 4 months and yearly after radiotherapy. Result(s): To date, 13 patients have been successfully treated with a median age of 71 years (range: 65-83 years). As previously reported, neoadjuvant radiotherapy resulted in a tumour pathologic response in 11 of 13 patients with a median residual cellularity of 1% (range: 0-10%). With an average follow-up of 31.9 months (range: 24.4- 39.2 months), no disease recurrences or deaths were recorded. Acute radiation toxicities were limited to Grade 1 dermatitis and breast pain. At the one-year follow-up, 11 patients had Grade 1 toxicities (dermatitis, fibrosis, breast pain and chest wall pain), one patient had a Grade 2 fatty necrosis, and two patients had Grade 3 toxicities (wound infection and hematoma). Only Grade 1 toxicities remained at the two-year follow-up. One-year cosmetic results were good or excellent in 46% of patients according to their self-assessment and in 54% of them according to the nurse's evaluation. Two-year cosmetic results were unavailable due to in-person visits cancellations during the COVID-19 pandemic. Conclusion(s): This study demonstrates that a single fraction of neoadjuvant radiotherapy preceding breast-conserving surgery is feasible, relatively well tolerated and leads to a high level of pathologic response for most patients. The Grade 3 toxicities and underwhelming cosmetic results may indicate that the 3-month interval after radiotherapy places surgery in a post-radiation inflammatory phase. Larger trials are needed to better assess the long-term toxicities as well as the optimal timing and fractionation of this novel technique in the management of early-stage breast cancer. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
ABSTRACT
A collection of powerful diagnostic tools have been developed under the umbrellas of NATO for ionising radiation dose assessment (BAT, WinFRAT) and estimate of acute health effects in humans (WinFRAT, H-Module). We assembled a database of 191 ARS cases using the medical treatment protocols for radiation accident victims (n= 167) and the system for evaluation and archiving of radiation accidents based on case histories (n= 24) for training purposes of medical personnel. From 2016 to 2019, we trained 39 participants comprising MSc level radiobiology students in an on-site teaching class. Enforced by the covid-19 pandemic in 2020 for the first time, an online teaching of nine MSc radiobiology students replaced the on-site teaching. We found that: (a) limitations of correct diagnostic decision-making based on clinical signs and symptoms were experienced unrelated to the teaching format. (b) A significant performance decrease concerning online (first number in parenthesis) versus on-site teaching (reference and second number in parenthesis) was seen regarding the estimate time (31 vs 61 cases per hour, two-fold decrease,p= 0.005). Also, the accurate assessment of response categories (89.9% vs 96.9%,p= 0.001), ARS (92.4% vs 96.7%,p= 0.002) and hospitalisation (93.5% vs 97.0%,p= 0.002) decreased by around 3%-7%. The performances of the online attendees were mainly distributed within the lower quartile performance of on-site participants and the 25%-75% interquartile range increased 3-7-fold. (c) Comparison of dose estimates performed by training participants with hematologic acute radiation syndrome (HARS) severity mirrored the known limitations of dose alone as a surrogate parameter for HARS severity at doses less than 1.5 Gy, but demonstrated correct determination of HARS 2-4 and support for clinical decision making at dose estimates >1.5 Gy, regardless of teaching format. (d) Overall, one-third of the online participants showed substantial misapprehension and insecurities of elementary course content that did not occur after the on-site teaching.