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Abstract：
Recently, low dose radiotherapy delivered to the whole lung has been proposed as treatment for the pneumonia due to COVID-19. Although there is biological plausibility for its use, the evidence supporting its effectiveness is scarce, and the risks associated with it may be significant. Thus, based on a virtual case simulation, we estimated the risks of radiation-induced cancer (RIC) and cardiac disease.
Lifetime attributable risks (LAR) of RIC were calculated for the lung, liver, esophagus, and breast of female patients. The cardiovascular risk of exposure-induced death (REID) due to ischemic heart disease was also calculated. The doses received by the organs involved in the treatment were obtained from a simulation of conformal radiotherapy (RT) treatment, delivering a dose of 0.5 Gy-1.5 Gy to the lungs. We considered a LAR and REID <1% as acceptable, 1-2% cautionary, and >2% unacceptable.
The lung was at the highest risk for RIC (absolute LAR below 5200 cases/100,000 and 2250 cases/100,000 for women and men, respectively). For women, the breast had the second-highest LAR, especially for young women. The liver and esophagus had LARs below 700/100,000 for both sexes, with a higher incidence of esophageal cancer in women and liver cancer in men. Regarding the LAR cutoff, we observed an unacceptable or cautionary LAR for lung cancer in all women and men <60 years with an RT dose >1 Gy. LAR for lung cancer with an RT dose of 1 Gy was cautionary for women >60 years of age and men <40 years of age. No LAR estimation was unacceptable for the RT dose ≤0.7 Gy in all groups irrespective of sex or age at exposure. Only 0.5 Gy had an acceptable REID.
A RT dose ≤0.5 Gy provides an acceptable LAR estimate (≤1%) for RIC and REID, irrespective of sex and age. The current ongoing trials should initially use doses ≤0.5 Gy to maintain the risks at an acceptable level and include only patients who fail or do not have any other treatment option.
Lifetime attributable risks (LAR) of RIC were calculated for the lung, liver, esophagus, and breast of female patients. The cardiovascular risk of exposure-induced death (REID) due to ischemic heart disease was also calculated. The doses received by the organs involved in the treatment were obtained from a simulation of conformal radiotherapy (RT) treatment, delivering a dose of 0.5 Gy-1.5 Gy to the lungs. We considered a LAR and REID <1% as acceptable, 1-2% cautionary, and >2% unacceptable.
The lung was at the highest risk for RIC (absolute LAR below 5200 cases/100,000 and 2250 cases/100,000 for women and men, respectively). For women, the breast had the second-highest LAR, especially for young women. The liver and esophagus had LARs below 700/100,000 for both sexes, with a higher incidence of esophageal cancer in women and liver cancer in men. Regarding the LAR cutoff, we observed an unacceptable or cautionary LAR for lung cancer in all women and men <60 years with an RT dose >1 Gy. LAR for lung cancer with an RT dose of 1 Gy was cautionary for women >60 years of age and men <40 years of age. No LAR estimation was unacceptable for the RT dose ≤0.7 Gy in all groups irrespective of sex or age at exposure. Only 0.5 Gy had an acceptable REID.
A RT dose ≤0.5 Gy provides an acceptable LAR estimate (≤1%) for RIC and REID, irrespective of sex and age. The current ongoing trials should initially use doses ≤0.5 Gy to maintain the risks at an acceptable level and include only patients who fail or do not have any other treatment option.
摘要：
最近,已提出将低剂量放疗到全肺作为COVID-19肺炎的治疗方法。尽管它的使用具有生物学上的合理性，支持其有效性的证据很少，与之相关的风险可能很大。因此，基于虚拟案例仿真，我们估计了放射诱发的癌症(RIC)和心脏病的风险.
计算肺RIC的寿命归因风险（LAR），肝脏,食道,女性患者的乳房。还计算了缺血性心脏病引起的暴露诱发死亡（REID）的心血管风险。参与治疗的器官接受的剂量是从模拟适形放疗（RT）治疗中获得的，向肺部输送0.5Gy-1.5Gy的剂量。我们认为LAR和REID<1%是可以接受的，1-2%的警告，>2%是不可接受的。
肺的RIC风险最高（女性和男性的绝对LAR低于5200例/100,000和2250例/100,000，分别)。对女人来说,乳房有第二高的LAR,尤其是年轻女性。两种性别的肝脏和食道LAR均低于700/100,000，女性食管癌和男性肝癌的发病率较高。关于LAR截止，我们观察到所有<60岁的女性和男性在RT剂量>1Gy的肺癌患者的LAR表现为不可接受的或有警示性的.对于RT剂量为1Gy的肺癌，LAR对于年龄>60岁的女性和年龄<40岁的男性是警示性的。在所有组中，无论暴露时的性别或年龄，对于RT剂量≤0.7Gy，没有LAR估计是不可接受的。只有0.5Gy具有可接受的REID。
RT剂量≤0.5Gy为RIC和REID提供了可接受的LAR估计值（≤1％），不分性别和年龄。目前正在进行的试验最初应使用≤0.5Gy的剂量，以将风险维持在可接受的水平，并且仅包括失败或没有任何其他治疗选择的患者。
计算肺RIC的寿命归因风险（LAR），肝脏,食道,女性患者的乳房。还计算了缺血性心脏病引起的暴露诱发死亡（REID）的心血管风险。参与治疗的器官接受的剂量是从模拟适形放疗（RT）治疗中获得的，向肺部输送0.5Gy-1.5Gy的剂量。我们认为LAR和REID<1%是可以接受的，1-2%的警告，>2%是不可接受的。
肺的RIC风险最高（女性和男性的绝对LAR低于5200例/100,000和2250例/100,000，分别)。对女人来说,乳房有第二高的LAR,尤其是年轻女性。两种性别的肝脏和食道LAR均低于700/100,000，女性食管癌和男性肝癌的发病率较高。关于LAR截止，我们观察到所有<60岁的女性和男性在RT剂量>1Gy的肺癌患者的LAR表现为不可接受的或有警示性的.对于RT剂量为1Gy的肺癌，LAR对于年龄>60岁的女性和年龄<40岁的男性是警示性的。在所有组中，无论暴露时的性别或年龄，对于RT剂量≤0.7Gy，没有LAR估计是不可接受的。只有0.5Gy具有可接受的REID。
RT剂量≤0.5Gy为RIC和REID提供了可接受的LAR估计值（≤1％），不分性别和年龄。目前正在进行的试验最初应使用≤0.5Gy的剂量，以将风险维持在可接受的水平，并且仅包括失败或没有任何其他治疗选择的患者。
