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. 2021 Mar 15;109(4):859-866.
doi: 10.1016/j.ijrobp.2020.11.065. Epub 2020 Dec 2.

Low-Dose Whole-Lung Irradiation for COVID-19 Pneumonia: Final Results of a Pilot Study

Ahmad Ameri  1 , Pooya Ameri  2 , Nazanin Rahnama  1 , Majid Mokhtari  3 , Meghdad Sedaghat  4 , Fahimeh Hadavand  5 , Rama Bozorgmehr  6 , Mehrdad Haghighi  5 , Farzad Taghizadeh-Hesary  7
Affiliations

Low-Dose Whole-Lung Irradiation for COVID-19 Pneumonia: Final Results of a Pilot Study

Ahmad Ameri et al. Int J Radiat Oncol Biol Phys. .

Abstract

Introduction: Radiation therapy (RT), commonly used in cancer management, has been considered as one of the potential treatments for COVID-19 pneumonia. Here, we present the results of the pilot trial evaluating low-dose whole-lung irradiation (LD-WLI) in patients with COVID-19 pneumonia.

Methods: Ten patients with moderate COVID-19 pneumonia were treated with LD-WLI in a single fraction of 0.5 or 1.0 Gy along with the national protocol. The primary endpoint was an improvement in Spo2. The secondary endpoints were the number of days of hospital/intensive care unit stay, the number of intubations after RT, 28-day mortality, and changes in biomarkers. The response rate (RR) was defined as an increase in Spo2 upon RT with a rising or constant trend in the next 2 days, clinical recovery (CR) including patients who were discharged or acquired Spo2 ≥93% on room air, and 28-day mortality rate defined based on days of RT.

Results: The median age was 75 years (80% male). Five, 1, and 4 patients received single-dose 0.5 Gy, two-dose 0.5 Gy, and single-dose 1.0 Gy LD-WLI, respectively. The mean improvement in Spo2 at days 1 and 2 after RT was 2.4% (±4.8%) and 3.6% (±6.1%), respectively, with improvement in 9 patients after 1 day. Five, 1, and 4 patients were discharged, opted out of the trial, and died in the hospital, respectively. Two of 5 discharged patients died within 3 days at home. Among discharged patients, the Spo2 at discharge was 81% to 88% in 3 patients and 93% in the other 2 patients. Overall, the RR and CR were 63.6% and 55.5%, respectively. The RR, CR, and 28-day mortality of the single 0.5 Gy and 1.0 Gy WLI groups were 71.4% versus 50% (P = .57), 60% versus 50% (P = .64), and 50% versus 75% (P = .57), respectively.

Conclusion: LD-WLI with a single fraction of 0.5 Gy or 1 Gy is feasible. A randomized trial with patients who do not receive radiation is required to assess the efficacy of LD-WLI for COVID-19.

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Figures

Fig. 1
Fig. 1
Evolution in time of (A) O2 saturation, (B) body temperature, (C) C-reactive peptide, and (D) IL-6 in patients with COVID-19 pneumonia after whole-lung irradiation.
Fig. 2
Fig. 2
Evolution in time of (A) ferritin, (B) procalcitonin, and (C) D-dimer in patients with COVID-19 pneumonia after whole-lung irradiation.
See this image and copyright information in PMC

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