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1.
An Acad Bras Cienc ; 94(4): e20210056, 2022.
Article in English | MEDLINE | ID: covidwho-1963128

ABSTRACT

The extreme demand on health systems due to the COVID-19 pandemic has led to reconsider hypofractionation. Although the best clinical efficacy of these schemes is being demonstrated, the biological bases have not been established. Thus, after validating basic clinical parameters, through complementary in vitro models, we characterized the cellular and molecular mechanisms of hypofractionation protocols. Cell cultures of human lung cancer cell line A549 were irradiated with 0, 2, 4, 8, 12, 16 and 20 Gy. The clastogenic, cytotoxic, proliferative and clonogenic capacities and bystander effect were evaluated. In addition, we assessed survival and toxicity in a retrospective study of 49 patients with lung cancer. Our findings showed that the greater efficacy of ablative regimens should not only be attributed to events of direct cell death induced by genotoxic damage, but also to a lower cell repopulation and the indirect action of clastogenic factors secreted. These treatments were optimal in terms of 1- and 2-year overall survival (74 and 65%, respectively), and progression-free survival at 1 and 2 years (71 and 61%, respectively). The greater efficacy of high doses per fraction could be attributed to a multifactorial mechanism that goes beyond the 4Rs of conventional radiotherapy.


Subject(s)
COVID-19 , Lung Neoplasms , COVID-19/radiotherapy , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Pandemics , Radiation Dose Hypofractionation , Retrospective Studies
2.
Int J Radiat Oncol Biol Phys ; 113(5): 946-959, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1821289

ABSTRACT

PURPOSE: Studies dating back to a century ago have reported using low-dose radiation therapy for the treatment of viral and bacterial pneumonia. In the modern era, since the COVID-19 pandemic began, several groups worldwide have researched the applicability of whole lung irradiation (WLI) for the treatment of COVID-19. We aimed to bring together the results of these experimental studies. METHODS AND MATERIALS: We performed a systematic review and meta-analysis searching PubMed and Scopus databases for clinical trials incorporating WLI for the treatment of patients with COVID-19. Required data were extracted from each study. Using the random-effects model, the overall pooled day 28 survival rate, survival hazard ratio, and intubation-free days within 15 days after WLI were calculated, and forest plots were produced. RESULTS: Ten studies were identified, and eventually, 5 were included for meta-analysis. The overall survival hazard ratio was calculated to be 0.85 (0.46-1.57). The pooled mean difference of intubation-free days within 15 days after WLI was 1.87, favoring the WLI group (95% confidence interval, -0.02 to 3.76). The overall day 28 survival rate of patients receiving WLI for the 9 studies with adequate follow-up data was 74% (95% confidence interval, 61-87). Except for 2 studies, the other 8 studies were assessed to have moderate to high risk of bias, and there were many differences among the designs of the studies, included patients, primary endpoints, outcome measurement methods, and reporting of the results. CONCLUSIONS: Despite a mild improvement in intubation-free days, WLI had no significant effect on patients' overall survival. Currently, we cannot recommend routine use of WLI for the treatment of patients with moderate-to-severe COVID-19.


Subject(s)
COVID-19 , Lung Neoplasms , Humans , Lung/radiation effects , Lung Neoplasms/radiotherapy , Pandemics
3.
Expert Rev Anticancer Ther ; 22(5): 549-559, 2022 May.
Article in English | MEDLINE | ID: covidwho-1806096

ABSTRACT

INTRODUCTION: Stage III non-small cell lung cancer (NSCLC) is a variable entity, encompassing bulky primary tumors, nodal involvement, or both. Multidisciplinary evaluation is essential to discuss multiple treatment options, to outline optimal management, and to examine the main debated topics and critical issues not addressed by current trials and guidelines that influence daily clinical practice. AREAS COVERED: From March to 5 May 2021 ,meetings were scheduled in a webinar format titled 'Radio Talk' due to the COVID-19 pandemic; the faculty was composed of 6 radiation oncologists from 6 different Institutions of Italy, all of them were the referring radiation oncologist for lung cancer treatment at their respective departments and were or had been members of AIRO (Italian Association of Radiation Oncology) Thoracic Oncology Study Group. The topics covered included: pulmonary toxicity, cardiac toxicity, radiotherapy dose, fractionation and volumes, unfit/elderly patients, multidisciplinary management. EXPERT OPINION: The debate was focused on the unmet needs triggered by case reports, personal experiences and questions; the answers were often not univocal; however, the exchange of opinion and the contribution of different centers confirmed the role of multidisciplinary management and the necessity that the most critical issues should be investigated in clinical trials.


Subject(s)
COVID-19 , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/radiotherapy , Humans , Lung Neoplasms/pathology , Lung Neoplasms/radiotherapy , Neoplasm Staging , Pandemics , Radiation Oncologists
4.
Med Phys ; 49(1): 420-431, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1544357

ABSTRACT

PURPOSE: Motion-mask segmentation from thoracic computed tomography (CT) images is the process of extracting the region that encompasses lungs and viscera, where large displacements occur during breathing. It has been shown to help image registration between different respiratory phases. This registration step is, for example, useful for radiotherapy planning or calculating local lung ventilation. Knowing the location of motion discontinuity, that is, sliding motion near the pleura, allows a better control of the registration preventing unrealistic estimates. Nevertheless, existing methods for motion-mask segmentation are not robust enough to be used in clinical routine. This article shows that it is feasible to overcome this lack of robustness by using a lightweight deep-learning approach usable on a standard computer, and this even without data augmentation or advanced model design. METHODS: A convolutional neural-network architecture with three 2D U-nets for the three main orientations (sagittal, coronal, axial) was proposed. Predictions generated by the three U-nets were combined by majority voting to provide a single 3D segmentation of the motion mask. The networks were trained on a database of nonsmall cell lung cancer 4D CT images of 43 patients. Training and evaluation were done with a K-fold cross-validation strategy. Evaluation was based on a visual grading by two experts according to the appropriateness of the segmented motion mask for the registration task, and on a comparison with motion masks obtained by a baseline method using level sets. A second database (76 CT images of patients with early-stage COVID-19), unseen during training, was used to assess the generalizability of the trained neural network. RESULTS: The proposed approach outperformed the baseline method in terms of quality and robustness: the success rate increased from 53 % to 79 % without producing any failure. It also achieved a speed-up factor of 60 with GPU, or 17 with CPU. The memory footprint was low: less than 5 GB GPU RAM for training and less than 1 GB GPU RAM for inference. When evaluated on a dataset with images differing by several characteristics (CT device, pathology, and field of view), the proposed method improved the success rate from 53 % to 83 % . CONCLUSION: With 5-s processing time on a mid-range GPU and success rates around 80 % , the proposed approach seems fast and robust enough to be routinely used in clinical practice. The success rate can be further improved by incorporating more diversity in training data via data augmentation and additional annotated images from different scanners and diseases. The code and trained model are publicly available.


Subject(s)
COVID-19 , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Four-Dimensional Computed Tomography , Humans , Image Processing, Computer-Assisted , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/radiotherapy , SARS-CoV-2
6.
Clin Oncol (R Coll Radiol) ; 34(1): 19-27, 2022 01.
Article in English | MEDLINE | ID: covidwho-1487658

ABSTRACT

AIMS: In response to the COVID-19 pandemic, guidelines on reduced fractionation for patients treated with curative-intent radiotherapy were published, aimed at reducing the number of hospital attendances and potential exposure of vulnerable patients to minimise the risk of COVID-19 infection. We describe the changes that took place in the management of patients with stage I-III lung cancer from April to October 2020. MATERIALS AND METHODS: Lung Radiotherapy during the COVID-19 Pandemic (COVID-RT Lung) is a prospective multicentre UK cohort study. The inclusion criteria were: patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between 2nd April and 2nd October 2020. Patients who had had a change in their management and those who continued with standard management were included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment were collected and reported as counts and percentages. Patient characteristics associated with a change in treatment were analysed using multivariable binary logistic regression. RESULTS: In total, 1553 patients were included (median age 72 years, 49% female); 93 (12%) had a change to their diagnostic investigation and 528 (34%) had a change to their treatment from their centre's standard of care as a result of the COVID-19 pandemic. Age ≥70 years, male gender and stage III disease were associated with a change in treatment on multivariable analysis. Patients who had their treatment changed had a median of 15 fractions of radiotherapy compared with a median of 20 fractions in those who did not have their treatment changed. Low rates of COVID-19 infection were seen during or after radiotherapy, with only 21 patients (1.4%) developing the disease. CONCLUSIONS: The COVID-19 pandemic resulted in changes to patient treatment in line with national recommendations. The main change was an increase in hypofractionation. Further work is ongoing to analyse the impact of these changes on patient outcomes.


Subject(s)
COVID-19 , Lung Neoplasms , Aged , COVID-19 Testing , Cohort Studies , Female , Humans , Lung Neoplasms/epidemiology , Lung Neoplasms/radiotherapy , Male , Pandemics , Prospective Studies , SARS-CoV-2 , United Kingdom/epidemiology
7.
In Vivo ; 35(6): 3333-3337, 2021.
Article in English | MEDLINE | ID: covidwho-1485629

ABSTRACT

BACKGROUND/AIM: A considerable number of patients with lung cancer are scheduled for definitive or adjuvant radiotherapy. Prevalence and potential risk factors of pre-radiotherapy sleep disturbances were evaluated. PATIENTS AND METHODS: Nineteen factors were retrospectively investigated for associations with pre-radiotherapy sleep disturbances in 77 lung cancer patients. Factors included COVID-19 pandemic; age; gender; performance score; comorbidity index; history of another malignancy; distress score; number of emotional, physical or practical problems; patient's request for psychological support; histology; tumor stage; upfront surgery; chemotherapy; and type of radiotherapy. RESULTS: Thirty-one patients (40.3%) reported sleep disturbances that were significantly associated with distress score 6-10 (p=0.019), ≥2 emotional problems (p=0.001), ≥5 physical problems (p<0.001), and request for psychological support (p=0.006). Trends were found for female gender (p=0.064) and stereotactic body radiation therapy (p=0.057). CONCLUSION: Many lung cancer patients assigned to radiotherapy reported sleep disturbances. Risk factors can be used to identify patients in need of psychological support already before treatment.


Subject(s)
COVID-19 , Lung Neoplasms , Female , Humans , Lung Neoplasms/complications , Lung Neoplasms/epidemiology , Lung Neoplasms/radiotherapy , Pandemics , Radiotherapy, Adjuvant/adverse effects , Retrospective Studies , SARS-CoV-2 , Sleep
9.
J Thorac Oncol ; 16(11): 1946-1951, 2021 11.
Article in English | MEDLINE | ID: covidwho-1316566

ABSTRACT

INTRODUCTION: Screening for coronavirus disease 2019 (COVID-19) exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. After two reported case studies of imaging findings during daily computed tomography (CT)-based image-guided radiotherapy (RT) scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates found during RT and COVID-19. We hereby report the results of the aggregate analysis. METHODS: Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during RT were submitted through an online portal. Information requested included a patient's sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to reveal the presence or absence of ground-glass opacities or infiltrates. RESULTS: A total of seven reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States. Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of nine patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction-based methods or nasopharyngeal swabs. Of the nine patients analyzed, abnormalities consistent with ground-glass opacities or infiltrates were observed in eight patients. CONCLUSIONS: This is the largest case series revealing the potential use of CT-based image guidance during RT as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates and immediate COVID-19 testing in patients who develop new infiltrates even without COVID-19 symptoms are strongly encouraged.


Subject(s)
COVID-19 , Lung Neoplasms , COVID-19 Testing , Humans , Lung , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/radiotherapy , SARS-CoV-2 , Tomography, X-Ray Computed
10.
Int J Radiat Oncol Biol Phys ; 110(4): 957-961, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1116868

ABSTRACT

Radiation recall phenomenon (RRP) is an uncommon, late occurring, acute inflammatory skin reaction that emerges in localized areas coincident with previously irradiated radiation therapy (RT) treatment fields. RRP has been known to be triggered by a number of chemotherapy agents. To the best of our knowledge, this report is the first description of RRP after administration of the Pfizer-BioNTech vaccine for COVID-19, or any other currently available vaccine against COVID-19. Acute skin reactions were observed in 2 RT patients with differing timelines of RT and vaccinations. In both cases however, the RRP presented within days of the patient receiving the second dose of vaccine. For each RT course, the treatment planning dosimetry of the radiation fields was compared with the area of the observable RRP. RRP developed within the borders of treatment fields where prescription dose constraints were prioritized over skin sparing. Our observation is currently limited to 2 patients. The actual incidence of RRP in conjunction with Pfizer-BioNTech vaccine or any other vaccine against COVID-19 is unknown. For patients with cancer being treated with radiation with significant dose to skin, consideration should be given to the probability of RRP side effects from vaccinations against COVID-19.


Subject(s)
COVID-19 Vaccines/adverse effects , Immunization, Secondary/adverse effects , Lung Neoplasms/radiotherapy , Radiodermatitis/etiology , Sarcoma/radiotherapy , Skin Neoplasms/radiotherapy , Aged , COVID-19 Vaccines/administration & dosage , Humans , Immunization Schedule , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Radiodermatitis/pathology , Radiosurgery/methods , Sarcoma/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Spinal Cord Compression/surgery , Thoracic Wall
12.
Ann Surg ; 272(6): 925-929, 2020 12.
Article in English | MEDLINE | ID: covidwho-873175

ABSTRACT

OBJECTIVE: To evaluate the overall survival of patients with operable stage IA non-small-cell lung cancer (NSCLC) who undergo "early" SBRT (within 0-30 days after diagnosis) versus "delayed" surgery (90-120 days after diagnosis). SUMMARY OF BACKGROUND DATA: During the COVID-19 pandemic, national guidelines have recommended patients with operable stage IA NSCLC to consider delaying surgery by at least 3 months or, alternatively, to undergo SBRT without delay. It is unknown which strategy is associated with better short- and long-term outcomes. METHODS: Multivariable Cox proportional hazards modeling and propensity score-matched analysis was used to compare the overall survival of patients with stage IA NSCLC in the National Cancer Data Base from 2004 to 2015 who underwent "early" SBRT (0-30 days after diagnosis) versus that of patients who underwent "delayed" wedge resection (90-120 days after diagnosis). RESULTS: During the study period, 570 (55%) patients underwent early SBRT and 475 (45%) underwent delayed wedge resection. In multivariable analysis, delayed resection was associated with improved survival [adjusted hazard ratio 0.61; (95% confidence interval (CI): 0.50-0.76)]. Propensity-score matching was used to create 2 groups of 279 patients each who received early SBRT or delayed resection that were well-matched with regard to baseline characteristics. The 5-year survival associated with delayed resection was 53% (95% CI: 45%-61%) which was better than the 5-year survival associated with early SBRT (31% [95% CI: 24%-37%]). CONCLUSION: In this national analysis, for patients with stage IA NSCLC, extended delay of surgery was associated with improved survival when compared to early treatment with SBRT.


Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/radiotherapy , Lung Neoplasms/surgery , Radiosurgery , COVID-19 , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Cohort Studies , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Neoplasm Staging , SARS-CoV-2 , Survival Rate , Time Factors , Time-to-Treatment
13.
Int J Med Sci ; 17(16): 2561-2569, 2020.
Article in English | MEDLINE | ID: covidwho-833375

ABSTRACT

Background: During the outbreak period of COVID-19 pneumonia, cancer patients have been neglected and in greater danger. Furthermore, the differential diagnosis between COVID-19 pneumonia and radiation pneumonitis in cancer patients remains a challenge. This study determined their clinical presentations and radiological features in order to early diagnose and separate COVID-19 pneumonia from radiation pneumonitis patients promptly. Methods and Findings: From January 21, 2020 to February 18, 2020, 112 patients diagnosed with suspected COVID-19 were selected consecutively. A retrospective analysis including all patients' presenting was performed. Four patients from 112 suspected individals were selected, including 2 males and 2 females with a median age of 54 years (range 39-64 years). After repeated pharyngeal swab nucleic acid tests, 1 case was confirmed and 3 cases were excluded from COVID-19 pneumonia. Despite the comparable morphologic characteristics of lung CT imaging, the location, extent, and distribution of lung lesions between COVID-19 pneumonia and radiation pneumonitis differed significantly. Conclusions: Lung CT imaging combined with clinical and laboratory findings can facilitate early diagnosis and appropriate management of COVID-19 pneumonia with a history of malignancy and radiation therapy.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Diagnosis, Differential , Neoplasms/radiotherapy , Pneumonia, Viral/diagnostic imaging , Radiation Pneumonitis/diagnostic imaging , Adult , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/pathology , Esophageal Neoplasms/radiotherapy , Female , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/radiotherapy , Male , Middle Aged , Nasopharyngeal Neoplasms/diagnostic imaging , Nasopharyngeal Neoplasms/pathology , Nasopharyngeal Neoplasms/radiotherapy , Neoplasms/virology , Pandemics , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
14.
Int J Radiat Oncol Biol Phys ; 107(4): 631-640, 2020 07 15.
Article in English | MEDLINE | ID: covidwho-615865

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused radiotherapy resource pressures and led to increased risks for lung cancer patients and healthcare staff. An international group of experts in lung cancer radiotherapy established this practice recommendation pertaining to whether and how to adapt radiotherapy for lung cancer in the COVID-19 pandemic. METHODS: For this ESTRO & ASTRO endorsed project, 32 experts in lung cancer radiotherapy contributed to a modified Delphi consensus process. We assessed potential adaptations of radiotherapy in two pandemic scenarios. The first, an early pandemic scenario of risk mitigation, is characterized by an altered risk-benefit ratio of radiotherapy for lung cancer patients due to their increased susceptibility for severe COVID-19 infection, and minimization of patient travelling and exposure of radiotherapy staff. The second, a later pandemic scenario, is characterized by reduced radiotherapy resources requiring patient triage. Six common lung cancer cases were assessed for both scenarios: peripherally located stage I NSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radiotherapy and prophylactic cranial irradiation for limited stage SCLC and palliative thoracic radiotherapy for stage IV NSCLC. RESULTS: In a risk-mitigation pandemic scenario, efforts should be made not to compromise the prognosis of lung cancer patients by departing from guideline-recommended radiotherapy practice. In that same scenario, postponement or interruption of radiotherapy treatment of COVID-19 positive patients is generally recommended to avoid exposure of cancer patients and staff to an increased risk of COVID-19 infection. In a severe pandemic scenario characterized by reduced resources, if patients must be triaged, important factors for triage include potential for cure, relative benefit of radiation, life expectancy, and performance status. Case-specific consensus recommendations regarding multimodality treatment strategies and fractionation of radiotherapy are provided. CONCLUSION: This joint ESTRO-ASTRO practice recommendation established pragmatic and balanced consensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic.


Subject(s)
Consensus , Coronavirus Infections/epidemiology , Lung Neoplasms/radiotherapy , Medical Oncology , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Societies, Medical , COVID-19 , Humans , Risk Management , Triage
15.
Clin Oncol (R Coll Radiol) ; 32(8): 481-489, 2020 08.
Article in English | MEDLINE | ID: covidwho-245621

ABSTRACT

Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic. Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.


Subject(s)
Betacoronavirus , Carcinoma, Non-Small-Cell Lung/radiotherapy , Coronavirus Infections/complications , Dose Fractionation, Radiation , Lung Neoplasms/radiotherapy , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Small Cell Lung Carcinoma/radiotherapy , COVID-19 , Carcinoma, Non-Small-Cell Lung/virology , Clinical Trials as Topic , Coronavirus Infections/virology , Humans , Lung Neoplasms/virology , Meta-Analysis as Topic , Pandemics , Pneumonia, Viral/virology , Risk Management , SARS-CoV-2 , Small Cell Lung Carcinoma/virology , Systematic Reviews as Topic
17.
Cancer Radiother ; 24(3): 182-187, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-100544

ABSTRACT

Overall treatment time is an important factor of local recurrence and indirectly of distant evolution, namely in case of protracted treatments. The current pandemic impacts on the duration of radiotherapy if patients under treatments and synchronously suffering from COVID-19. The models used to compensate the total dose in case of temporary treatment interruption are well known but it is of importance in that pandemic context to update and homogenize clinical practice in order to improve local control without increasing normal tissue complications.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Neoplasms/radiotherapy , Pandemics , Pneumonia, Viral/epidemiology , Withholding Treatment , Breast Neoplasms/radiotherapy , COVID-19 , Carcinoma, Non-Small-Cell Lung/radiotherapy , Cell Proliferation , Female , Humans , Lung Neoplasms/radiotherapy , Male , Neoplasms/pathology , Prostatic Neoplasms/radiotherapy , Radiobiology/methods , Radiotherapy Dosage , SARS-CoV-2 , Time Factors , Uterine Cervical Neoplasms/radiotherapy
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