Coronavirus disease-2019 (COVID-19) has become a global health crisis. Mortality associated with COVID-19 is characterized mainly by acute respiratory distress syndrome (ARDS), sepsis, pneumonia, and respiratory failure. The pathogenesis of the disease is known to be associated with pro-inflammatory processes after virus infection. Hence, various therapeutic strategies are being developed to control the inflammation and cytokine storm in COVID-19 patients. Recently, low-dose radiation therapy (LDRT) has been suggested for the treatment of pneumonia/ADRS in COVID-19 patients through irradiation of lungs by gamma/X-ray. In this direction, a few clinical trials have also been initiated. However, a few recent publications have raised some concerns regarding LDRT, especially about possibilities of activation/aggressiveness of virus (severe acute respiratory syndrome coronavirus 2 in case of COVID-19), lung injury and risk of second cancer after low-dose therapy. The present manuscript is an attempt to analyze these apprehensions based on cited references and other available literature, including some from our laboratory. At this point, LDRT may be not the first line of therapy. However, based on existing anti-inflammatory evidence of LDRT, it needs encouragement as an adjuvant therapy and for more multi-centric clinical trials. In addition, it would be worth combining LDRT with other anti-inflammatory therapies, which would open avenues for multi-modal therapy of pneumonia/ARDS in COVID-19 patients. The mode of irradiation (local lung irradiation or whole-body irradiation) and the window period after infection of the virus, need to be optimized using suitable animal studies for effective clinical outcomes of LDRT. However, considering ample evidence, it is time to look beyond the apprehensions if a low dose of radiation could be exploited for better management of COVID-19 patients.


中文翻译：

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低剂量放射治疗治疗 2019 年冠状病毒病肺炎：是时候超越忧虑了吗？


2019 年冠状病毒病 (COVID-19) 已成为一场全球健康危机。与 COVID-19 相关的死亡主要表现为急性呼吸窘迫综合征 (ARDS)、败血症、肺炎和呼吸衰竭。已知该疾病的发病机制与病毒感染后的促炎过程有关。因此，正在开发各种治疗策略来控制 COVID-19 患者的炎症和细胞因子风暴。最近，低剂量放射治疗（LDRT）被建议通过伽马/X射线照射肺部来治疗COVID-19患者的肺炎/ADRS。在这个方向上，一些临床试验也已经启动。然而，最近的一些出版物提出了有关 LDRT 的一些担忧，特别是病毒激活/攻击性的可能性（在 COVID-19 的情况下为严重急性呼吸综合征冠状病毒 2）、肺损伤以及低剂量治疗后罹患第二种癌症的风险。本手稿试图根据引用的参考文献和其他可用文献（包括我们实验室的一些文献）来分析这些担忧。目前，LDRT 可能不是一线治疗方法。然而，基于LDRT现有的抗炎证据，需要鼓励其作为辅助治疗和更多的多中心临床试验。此外，将 LDRT 与其他抗炎疗法结合起来也是值得的，这将为 COVID-19 患者肺炎/ARDS 的多模式治疗开辟途径。需要利用合适的动物研究来优化照射模式（局部肺部照射或全身照射）和病毒感染后的窗口期，以获得有效的 LDRT 临床结果。然而，考虑到充足的证据，现在是时候超越担忧，看看是否可以利用低剂量辐射来更好地管理 COVID-19 患者。