Carbon Ion Radiotherapy Acts as the Optimal Treatment Strategy for Unresectable Liver Cancer During the Coronavirus Disease 2019 Crisis

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has greatly disrupted the normal treatment of patients with liver cancer and increased their risk of death. The weight of therapeutic safety was significantly amplified for decision-making to minimize the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, the safety and effectiveness of carbon ion radiotherapy (CIRT) for unresectable liver cancer (ULC) were evaluated, and Chinese experiences were shared to solve the predicament of ULC treatment caused by SARS-CoV-2. Worldwide studies were collected to evaluate CIRT for ULC as the world has become a community due to the COVID-19 pandemic. We not only searched five international databases including the Cochrane Library, Web of Science, PubMed, Embase, and Scopus but also performed supplementary retrieval with other sources. Chinese experiences of fighting against COVID-19 were introduced based on the advancements of CIRT in China and a prospective clinical trial of CIRT for treating ULC. A total of 19 studies involving 813 patients with ULC were included in the systematic review. The qualitative synthetic evaluation showed that compared with transarterial chemoembolization (TACE), CIRT could achieve superior overall survival, local control, and relative hepatic protection. The systematic results indicated that non-invasive CIRT could significantly minimize harms to patients with ULC and concurrently obtain superior anti-cancer effectiveness. According to the Chinese experience, CIRT allows telemedicine within the hospital (TMIH) to keep a sufficient person-to-person physical distance in the whole process of treatment for ULC, which is significant for cutting off the transmission route of SARS-CoV-2. Additionally, CIRT could maximize the utilization rate of hospitalization and outpatient care (UHO). Collectively, CIRT for ULC patients not only allows TMIH and the maximized UHO but also has the compatible advantages of safety and effectiveness. Therefore, CIRT should be identified as the optimal strategy for treating appropriate ULC when we need to minimize the risk of SARS-CoV-2 infection and to improve the capacity of medical service in the context of the unprecedented COVID-19 crisis.

The role transition of radiotherapy for the treatment of liver cancer in the COVID-19 era

“…Maybe the COVID-19 era is a primetime for the single-fraction (or shortened-course) radiotherapy in treating applicative liver cancer, which has been placed great expectations ( 10 , 17 , 18 ). Aitken et al ( 19 ) proposed that surgery for the patients with liver cancer could be provisionally replaced by the non-invasive stereotactic ablative radiotherapy (SABR) during the unprecedented COVID-19 crisis.…”

“…However, the conservative paradigm, SABR is only used as a bridge for the delayed surgery due to COVID-19 ( 23 ), should be considered as the preferred strategy until we obtain the conclusive evidence of comparison between SABR and surgery. Compared with SABR, carbon ion radiotherapy (CIRT) is a better alternative strategy to the delayed surgery for liver cancer due to its multidimensional superiorities ( 10 , 24 – 26 ), including target conformity, immune system and normal liver tissues sparing, relative biological effectiveness (RBE), total duration of treatment, and so on.…”

“…The inherently physical and biological superiorities enable CIRT to break through the limitations of conventional radiotherapy modalities in the treatment of liver cancer, maximize the anti-cancer efficacy while minimizing hepatotoxicity and immune-toxicity ( 10 , 25 , 26 ). CIRT possesses unique advantages to fight against COVID-19 and liver cancer synchronously in the SAUCCC ( 10 , 24 ).…”

“…The inherently physical and biological superiorities enable CIRT to break through the limitations of conventional radiotherapy modalities in the treatment of liver cancer, maximize the anti-cancer efficacy while minimizing hepatotoxicity and immune-toxicity ( 10 , 25 , 26 ). CIRT possesses unique advantages to fight against COVID-19 and liver cancer synchronously in the SAUCCC ( 10 , 24 ). Cutting off transmission routes could be well realized in the process of CIRT by the environmental eradication of SARS-CoV-2 and the remote treatment with the help of ultra-modern artificial intelligence (including robot) in the future ( 10 , 27 , 28 ).…”

“…As a matter of fact, the routine treatment of liver cancer was disrupted by the COVID-19 pandemic ( 8 , 9 ). The dilemma of liver cancer treatment needs to be noticed and further explored ( 10 ). Therefore, we expounded the role transition of radiotherapy in this mini review, which is a pragmatic solution for the balance between the risk of SARS-CoV-2 infection and malignant death of liver cancer during the unprecedented COVID-19 crisis.…”