Unethical not to Investigate Radiotherapy for COVID-19

Abstract

The primum non nocere letter by Boon et al. urged caution and careful examination of the evidence and logistics of low-dose radiotherapy in COVID-19 patients. This is exactly what was requested in March and what has occurred since late April 2020 when the first phase I/II clinical trial was approved at the Winship Cancer Institute, Emory University Hospital. The preprint of day-7 interim results by the investigators concluded, “In a small pilot trial of 5 oxygen-dependent patients with COVID-19 pneumonia, low-dose whole-lung radiation led to rapid improvement in clinical status, encephalopathy, and radiographic infiltrates without acute toxicity or worsening the cytokine storm. Low-dose whole-lung radiation appears to be safe, shows early promise of efficacy, and warrants larger prospective trials.” Preliminary results from another clinical trial gave similar results. In conclusion, the authors believe it would be unethical not to investigate radiotherapy as a potential remedy against COVID-19 induced pneumonia

Coming Out of Nowhere: The Paradox of the Birth of Omicron

“…Thus, we strongly suggested using selective-pressure-free treatments (e.g. low dose radiotherapy [11][12][13][14]) for COVID-19 pneumonia in sub-Saharan Africa. Moreover, effective vaccination of people with HIV in this region along with using high-efficiency face masks (with at least antibacterial, water repellent and water absorbing layers) would be of paramount importance.…”

The Paradox of COVID-19 in Sub-Saharan Africa: Why it is More Unethical Not to Investigate Low Dose Radiotherapy for COVID-19

“…Although some of the LDRT clinical trials conducted so far had methodological problems [18,19], the overall results show that this method can be introduced as a safe treatment with promising efficacy [20]. As addressed by Cuttler et al it is unethical not to investigate radiotherapy for COVID-19 [21]; this might be even more unethical in sub-Saharan Africa, where long CO-VID in millions of people with HIV paves the road for the emergence of new variants.…”

Low-Dose Lung Radiation Therapy for COVID-19 Lung Disease: A Preclinical Efficacy Study in a Bleomycin Model of Pneumonitis

“…Very recently, however, the first randomised clinical data to be published (n=22) showed no benefit of 1.0 Gy whole lung radiotherapy over sham irradiation in ventilationdependent patients with severe COVID-19 pneumonia (14). This therapeutic approach has generated intense controversy (15)(16)(17)(18). While expressing diverse opinions, the vast majority of stakeholders have emphasised the urgent need for high quality preclinical data to (i) justify (or not) the commencement of clinical studies, (ii) elucidate mechanisms of efficacy and (iii) inform decisions on radiation dose, scheduling and target volume (19).…”