Israeli doctors to ‘zap’ COVID-19 patients back to health in new treatment

While radiation is generally used in the management of malignant neoplasms, physicians worldwide have broadened its applicability to a variety of benign diseases.

By MAAYAN JAFFE-HOFFMAN
Ichilov Medical team at the coronavirus unit, in the Ichilov hospital, Tel Aviv, Israel, July 28, 2020. (photo credit: YOSSI ALONI/FLASH90)
Ichilov Medical team at the coronavirus unit, in the Ichilov hospital, Tel Aviv, Israel, July 28, 2020.
(photo credit: YOSSI ALONI/FLASH90)
A team of doctors at Sheba Medical Center in Tel Hashomer plans to conduct a clinical trial using low-dose radiation therapy to fight COVID-19. It would be the first of its kind in Israel and one of only a handful of similar studies worldwide.
Some 30 patients will participate in the study over the next 15 weeks, Prof. Zvi Symon of Sheba’s Radiation Oncology Department told The Jerusalem Post. The trial is based on the hypothesis that low-dose radiation therapy (LDRT) could improve clinical, radiographic and immune outcomes in hospitalized COVID-19 patients with pneumonia and severe acute respiratory syndrome, he said.
“When the COVID crisis began, there were some older radiotherapists in the world who remembered that 70 years ago some doctors were using low-dose radiation therapy to treat pneumonia,” Symon said.
Prof. Zvi Symon of Sheba’s Radiation Oncology Department (Credit: Courtesy of Sheba Medical Center)
Prof. Zvi Symon of Sheba’s Radiation Oncology Department (Credit: Courtesy of Sheba Medical Center)
Researchers started looking into that therapy and found that between 1905 and 1946, outcomes of some 700 pneumonia patients treated with LDRT showed that it led to measurable clinical improvements in the hours and days following administration. These included improved respiration, lower fever and a better chance of survival.
These studies took place before the era of randomized clinical trials and peer-reviewed journals, Symon said, adding: “It’s not quite clear today how many of these were bacterial pneumonia, how many [were] viral pneumonias and how many [were] immune-response pneumonias. But looking at those results was very encouraging.”
Soon after, Sheba doctors came upon a paper published by researchers at Emory University in Atlanta that showed when they treated five coronavirus patients with LDRT and compared the results to a control group, those who received it had 40% less need for mechanical ventilation and intensive care than those who did not receive it.
“When we saw this, we tried to raise interest at Sheba, and the head of the intensive-care unit in charge of coronavirus patients at Sheba was impressed by these findings – and frustrated by the fact that so many ICU patients were doing badly and there were no good therapies,” Symon told the Post.
The team was met with a lot of opposition by certain physicians who were scared of the side effects of radiation, but they did submit a proposal to the internal review board for human and animal trials, he said. They made a strong argument for their case and received Health Ministry approval this week.
“A process that would normally take months was completed in two and a half weeks, and after several rounds of clarifications and amendments and explanations, the Health Ministry has now approved the protocol,” Symon said. “Our goal is to kick off next week.”
WHILE RADIATION is generally used in the management of malignant neoplasms, physicians worldwide have broadened its applicability to a variety of benign diseases.
The protocol calls for one shot of radiation to both lungs in a very small dose – about a 70th or a 100th of the dose used to treat cancer, Symon said.
“There is no acute toxicity or damage associated with this kind of dose of radiation, at least to the naked eye,” he said.
But cells are sensitive and are impacted by the treatment, which – in the patients the hospital was able to treat until now under the compassionate-use umbrella – helped allow them to be weaned off oxygen and feel better and get better quickly, Symon said.
“Patients who received radiation improved and managed to go off oxygen and could breathe well in three to four days, whereas other patients who did not receive the radiation took an average 12 days after pneumonia,” he said.
The treatment needs to be given at the right time, which is the start of acute symptoms and before COVID-19 has caused overwhelming multi-organ damage, Symon said.
Carrying out the protocol is a “huge logistics issue,” he said. When the team wants to transport a patient who is COVID-19 positive, it needs to ensure there are no cancer patients in the radiation department. Until now, any compassionate-use treatments have been given after hours.
Coronavirus patients do not go through the hospital corridors; they are transported via a vehicle from a special exit in the COVID-19 ward to a special entrance in the radiation ward, by a team fully dressed in full personal protective gear. They receive the radiation and then are transported back to their ward. The procedure lasts about 30 to 40 minutes.
Once the patients finish receiving their treatment, a detoxification and sanitation team sterilizes the room – including the floor, the machines and anything else that might have been touched – to ensure the safety of cancer patients who will need radiation the next day.
The clinical trial will allow Sheba to administer radiation to patients up to twice a week, Symon told the Post.
“Radiation is still the most effective drug across all cancers,” he said. “We strongly believe that we will be able to save the lives of some of our grandfathers and grandmothers.”