Low-dose radiotherapy for COVID-19 pneumonia treatment: case report, procedure, and literature review

Abstract

Background: The COVID-19 pandemic outbreak has set the emergency services in developing countries on major alert, as the installed response capacities are easily overwhelmed by the constantly increasing high demand. The deficit of intensive care unit beds and ventilators in countries like Peru is forcing practitioners to seek preventive or early interventional strategies to prevent saturating these chronically neglected facilities.

Case presentation: A 64-year-old patient is reported after presenting with COVID-19 pneumonia and rapidly progressing to deteriorated ventilatory function. Compassionate treatment with a single 1‑Gy dose to the bilateral whole-lung volume was administered, with gradual daily improvement of ventilatory function and decrease in serum inflammatory markers and oxygen support needs, including intubation. No treatment-related toxicity developed. Procedures of transport, disinfection, and treatment planning and delivery are described.

Conclusion: Whole-lung low-dose radiotherapy seems to be a promising approach for avoiding or delaying invasive respiratory support. Delivered low doses are far from meeting toxicity ranges. On-going prospective trials will elucidate the effectiveness of this approach.

Keywords: COVID-19; Cytokine storm; Intensive care; Low-dose radiotherapy; Viral pneumonia.

Fig. 1

Baseline and eighth post-RT day imaging. Evident worsening of the inflammatory process can be observed; however, a dissociation between these finding and the good clinical evolution of the patient is to be noted

Fig. 2

1‑Gy isodose volume distribution and dose–volume histogram showing a conformal and homogeneous distribution profile on the desired target volume

Fig. 3

0.5 Gy isodose volume distribution and dose–volume histogram. The lower dose distribution profile reaches healthy surrounding structures without major clinical impact