Top

Radiation Oncology

Published in:

01-12-2022 | Pneumonia | Research

Estimating cancer risks due to whole lungs low dose radiotherapy with different techniques for treating COVID-19 pneumonia

Authors: Amin Banaei, Bijan Hashemi, Mohsen Bakhshandeh

Published in: Radiation Oncology | Issue 1/2022

Abstract

Background

Low dose radiotherapy (LDRT) of whole lungs with photon beams is a novel method for treating COVID-19 pneumonia. This study aimed to estimate cancer risks induced by lung LDRT for different radiotherapy delivery techniques.

Method

Four different radiotherapy techniques, including 3D-conformal with anterior and posterior fields (3D-CRT AP–PA), 3D-conformal with 8 coplanar fields (3D-CRT 8 fields), eight fields intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy using 2 full arcs (VMAT) were planned on the CT images of 32 COVID-19 patients with the prescribed dose of 1 Gy to the lungs. Organ average and maximum doses, and PTV dose distribution indexes were compared between different techniques. The radiation-induced cancer incidence and cancer-specific mortality, and cardiac heart disease risks were estimated for the assessed techniques.

Results

In IMRT and VMAT techniques, heart (mean and max), breast (mean, and max), and stomach (mean) doses and also maximum dose in the body were significantly lower than the 3D-CRT techniques. The calculated conformity indexes were similar in all the techniques. However, the homogeneity indexes were lower (i.e., better) in intensity-modulated techniques (P < 0.03) with no significant differences between IMRT and VMAT plans. Lung cancer incident risks for all the delivery techniques were similar (P > 0.4). Cancer incidence and mortality risks for organs located closer to lungs like breast and stomach were higher in 3D-CRT techniques than IMRT or VMAT techniques (excess solid tumor cancer incidence risks for a 30 years man: 1.94 ± 0.22% Vs. 1.68 ± 0.17%; and women: 6.66 ± 0.81% Vs. 4.60 ± 0.43%: cancer mortality risks for 30 years men: 1.63 ± 0.19% Vs. 1.45 ± 0.15%; and women: 3.63 ± 0.44% Vs. 2.94 ± 0.23%).

Conclusion

All the radiotherapy techniques had low cancer risks. However, the overall estimated risks induced by IMRT and VMAT radiotherapy techniques were lower than the 3D-CRT techniques and can be used clinically in younger patients or patients having greater concerns about radiation induced cancers.

Available only for authorised users

Hess CB, Buchwald ZS, Stokes W, Nasti TH, Switchenko JM, Weinberg BD, et al. Low-dose whole-lung radiation for COVID-19 pneumonia: planned day 7 interim analysis of a registered clinical trial. Cancer. 2020;126(23):5109–13.CrossRefPubMed

Rousseau JP, Johnson WM, Harrell GT. The value of roentgen therapy in pneumonia which fails to respond to the sulfonamides. Radiology. 1942;38(3):281–9.CrossRef

Scott WR. X-ray therapy in the treatment of acute pneumonia: report covering the use of X-ray therapy in the treatment of pneumonia at the Niagara Falls Memorial Hospital, from Oct. 1, 1937, to Sept.. 30, 1938. Radiology. 1939;33(3):331–49.CrossRef

Venkatraman P, Sahay JJ, Maidili T, Rajan R, Pooja S. Breakthrough of COVID-19 using radiotherapy treatment modalities. Radiother Oncol. 2020;148:225–6.CrossRefPubMedPubMedCentral

Lara PC, Burgos J, Macias D. Low dose lung radiotherapy for COVID-19 pneumonia. The rationale for a cost-effective anti-inflammatory treatment. Clin Transl Radiat Oncol. 2020;23:27–9.CrossRefPubMedPubMedCentral

Kirkby C, Mackenzie M. Is low dose radiation therapy a potential treatment for COVID-19 pneumonia? Radiother Oncol. 2020;147:221.CrossRefPubMedPubMedCentral

ClinicalTrials.gov. National library of medicine. Anti-inflammatory effect of low-dose whole-lung radiation for COVID-19 pneumonia; 2021. https://clinicaltrials.gov/ct2/show/NCT04534790?cond=radiotherapy+covid&draw=2&rank=13.

ClinicalTrials.gov. National library of medicine. COVID-19 pneumonitis low dose lung radiotherapy (COLOR-19). https://clinicaltrials.gov/ct2/show/NCT04377477?cond=radiotherapy+covid&draw=2&rank=1.

ClinicalTrials.gov. National library of medicine. Low dose pulmonary irradiation in patients with COVID-19 infection of bad prognosis (COVRTE-19) (May 2021). https://clinicaltrials.gov/ct2/show/NCT04414293?cond=radiotherapy+covid&draw=2&rank=8.

10.

ClinicalTrials.gov. National library of medicine. Low dose radiation therapy for Covid-19 pneumonia; 2021. https://clinicaltrials.gov/ct2/show/NCT04394793?cond=radiotherapy+covid&draw=2&rank=10.

11.

ClinicalTrials.gov. National library of medicine. Low dose radiation therapy for severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2), COVID-19 (COVID-RT-01); 2021. https://clinicaltrials.gov/ct2/show/NCT04598581?cond=radiotherapy+covid&draw=2&rank=12.

12.

ClinicalTrials.gov. National library of medicine. Low dose radiotherapy for COVID-19 pneumonitis (LOWRAD-Cov19); 2021. https://clinicaltrials.gov/ct2/show/NCT04420390?cond=radiotherapy+covid&draw=2&rank=2.

13.

ClinicalTrials.gov. National library of medicine. Low dose whole lung radiation therapy for patients with COVID-19 and respiratory compromise (VENTED); 2021. https://clinicaltrials.gov/ct2/show/NCT04427566?cond=radiotherapy+covid&draw=2&rank=9.

14.

ClinicalTrials.gov. National library of medicine. Low dose whole lung radiotherapy for older patients with COVID-19 pneumonitis; 2021. https://clinicaltrials.gov/ct2/show/NCT04493294?cond=radiotherapy+covid&draw=2&rank=4.

15.

ClinicalTrials.gov. National library of medicine. Low-dose radiotherapy for patients with SARS-COV-2 (COVID-19) pneumonia (PREVENT); 2021. https://clinicaltrials.gov/ct2/show/NCT04466683?cond=radiotherapy+covid&draw=2&rank=7.

16.

ClinicalTrials.gov. National library of medicine. Lung irradiation for COVID-19 pneumonia; 2021. https://clinicaltrials.gov/ct2/show/NCT04393948?cond=radiotherapy+covid&draw=2&rank=11.

17.

ClinicalTrials.gov. National library of medicine. Low dose lung radiotherapy to treat COVID-19 pneumonia; 2021. https://clinicaltrials.gov/ct2/show/NCT04572412?cond=radiotherapy+covid&draw=2&rank=5.

18.

Ameri A, Ameri P, Rahnama N, Mokhtari M, Sedaghat M, Hadavand F, et al. Low-dose whole-lung irradiation for COVID-19 pneumonia: final results of a pilot study. Int J Radiat Oncol Biol Phys. 2021;109(4):859–66.CrossRefPubMed

19.

Papachristofilou A, Finazzi T, Blum A, Zehnder T, Zellweger N, Lustenberger J et al. Low dose radiation therapy for severe COVID-19 pneumonia: a randomized double-blind study. Int J Radiat Oncol Biol Phys. 2021; 110:1274–82.

20.

Dhawan G, Kapoor R, Dhawan R, Singh R, Monga B, Giordano J, et al. Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS). Radiother Oncol. 2020;147:212–6.CrossRefPubMedPubMedCentral

21.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–4.CrossRefPubMedPubMedCentral

22.

Council NR. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. 2006.

23.

Schneider U, Sumila M, Robotka J. Site-specific dose-response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy. Theor Biol Med Model. 2011;8(1):1–21.CrossRef

24.

Schneider U, Zwahlen D, Ross D, Kaser-Hotz B. Estimation of radiation-induced cancer from three-dimensional dose distributions: concept of organ equivalent dose. Int J Radiat Oncol Biol Phys. 2005;61(5):1510–5.CrossRefPubMed

25.

Valentin J. International Commission on Radiological Protection. The 2007 recommendations of the international commission on radiological protection. Ann ICRP ICRP Publ. 2007;2007(103):2–4.

26.

van Nimwegen FA, Schaapveld M, Cutter DJ, Janus CP, Krol AD, Hauptmann M, et al. Radiation dose-response relationship for risk of coronary heart disease in survivors of Hodgkin lymphoma. 2016.

27.

Boldea V, Sarrut D, Clippe S. Lung deformation estimation with non-rigid registration for radiotherapy treatment. In: International conference on medical image computing and computer-assisted intervention. Springer; 2003. p. 770–7.

28.

Keall PJ, Mageras GS, Balter JM, Emery RS, Forster KM, Jiang SB, et al. The management of respiratory motion in radiation oncology report of AAPM Task Group 76 a. Med Phys. 2006;33(10):3874–900.CrossRefPubMed

29.

Shimizu S, Shirato H, Kagei K, Nishioka T, Bo X, Dosaka-Akita H, et al. Impact of respiratory movement on the computed tomographic images of small lung tumors in three-dimensional (3D) radiotherapy. Int J Radiat Oncol Biol Phys. 2000;46(5):1127–33.CrossRefPubMed

30.

Weiss E, Robertson SP, Mukhopadhyay N, Hugo GD. Tumor, lymph node, and lymph node-to-tumor displacements over a radiotherapy series: analysis of interfraction and intrafraction variations using active breathing control (ABC) in lung cancer. Int J Radiat Oncol Biol Phys. 2012;82(4):e639–45.CrossRefPubMed

31.

Unscear. UNSCEAR 2006 Report Vol. I: Effects of Ionizing Radiation. United Nations New York; 2006.

32.

Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98.CrossRefPubMed

33.

Wambersie A. ICRU report 62, prescribing, recording and reporting photon beam therapy (supplement to ICRU Report 50). ICRU News. 1999.

34.

García-Hernández T, Romero-Expósito M, Sánchez-Nieto B. Low dose radiation therapy for COVID-19: effective dose and estimation of cancer risk. Radiother Oncol. 2020;153:289–95.CrossRefPubMedPubMedCentral

35.

Calabrese EJ, Dhawan G. How radiotherapy was historically used to treat pneumonia: could it be useful today? Yale J Biol Med. 2013;86(4):555.PubMedPubMedCentral

36.

Sánchez-Nieto B, Romero-Expósito M, Terrón JA, Sánchez-Doblado F. Uncomplicated and cancer-free control probability (UCFCP): a new integral approach to treatment plan optimization in photon radiation therapy. Phys Med. 2017;1(42):277–84.CrossRef

37.

Schneider U. Mechanistic model of radiation-induced cancer after fractionated radiotherapy using the linear-quadratic formula. Med Phys. 2009;36(4):1138–43.CrossRefPubMed

38.

Shuryak I, Hahnfeldt P, Hlatky L, Sachs RK, Brenner DJ. A new view of radiation-induced cancer: integrating short- and long-term processes. Part II: second cancer risk estimation. Radiat Environ Biophys. 2009;48(3):275–86.CrossRefPubMedPubMedCentral

39.

Daşu A, Toma-Daşu I, Olofsson J, Karlsson M. The use of risk estimation models for the induction of secondary cancers following radiotherapy. Acta Oncol Stockh Swed. 2005;44(4):339–47.CrossRef

40.

Sachs RK, Brenner DJ. Solid tumor risks after high doses of ionizing radiation. Proc Natl Acad Sci U S A. 2005;102(37):13040–5.CrossRefPubMedPubMedCentral

41.

O’Connor MK, Li H, Rhodes DJ, Hruska CB, Clancy CB, Vetter RJ. Comparison of radiation exposure and associated radiation-induced cancer risks from mammography and molecular imaging of the breast a. Med Phys. 2010;37(12):6187–98.CrossRefPubMedPubMedCentral

42.

Harrison RM. Doses to organs and tissues from concomitant imaging in radiotherapy: a suggested framework for clinical justification. Br J Radiol. 2008;81(972):970–4.CrossRefPubMed

43.

Charles MW. ICRP publication 103: recommendations of the ICRP. Oxford University Press; 2008.

44.

Darby SC, Cutter DJ, Boerma M, Constine LS, Fajardo LF, Kodama K, et al. Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys. 2010;76(3):656–65.CrossRefPubMedPubMedCentral

45.

Mulrooney DA, Yeazel MW, Kawashima T, Mertens AC, Mitby P, Stovall M, et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ. 2009;339:b4606.CrossRefPubMedPubMedCentral

46.

Shrestha S, Bates JE, Liu Q, Smith SA, Oeffinger KC, Chow EJ, et al. Radiation therapy related cardiac disease risk in childhood cancer survivors: Updated dosimetry analysis from the Childhood Cancer Survivor Study. Radiother Oncol. 2021;163:199–208.

47.

Schwarz M, Cattaneo GM, Marrazzo L. Geometrical and dosimetrical uncertainties in hypofractionated radiotherapy of the lung: a review. Phys Medica Eur J Med Phys. 2017;1(36):126–39.

48.

Zhen H, Hrycushko B, Lee H, Timmerman R, Pompoš A, Stojadinovic S, et al. Dosimetric comparison of Acuros XB with collapsed cone convolution/superposition and anisotropic analytic algorithm for stereotactic ablative radiotherapy of thoracic spinal metastases. J Appl Clin Med Phys. 2015;16(4):181–92.CrossRefPubMedPubMedCentral

Title: Estimating cancer risks due to whole lungs low dose radiotherapy with different techniques for treating COVID-19 pneumonia
Authors: Amin Banaei
Bijan Hashemi
Mohsen Bakhshandeh
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Pneumonia
Radiotherapy
COVID-19
Published in: Radiation Oncology / Issue 1/2022
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-021-01971-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Estimating cancer risks due to whole lungs low dose radiotherapy with different techniques for treating COVID-19 pneumonia

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Radiation pneumonitis prediction after stereotactic body radiation therapy based on 3D dose distribution: dosiomics and/or deep learning-based radiomics features

Knowledge-based DVH estimation and optimization for breast VMAT plans with and without avoidance sectors

Quality of life after definitive linear accelerator-based stereotactic radiotherapy for prostate cancer: a longitudinal study

Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases

MR-guided adaptive stereotactic body radiotherapy (SBRT) of primary tumor for pain control in metastatic pancreatic ductal adenocarcinoma (mPDAC): an open randomized, multicentric, parallel group clinical trial (MASPAC)

Aggressive unifocal bone Langerhans cell histiocytosis with soft tissue extension both responsive to radiotherapy: a case report