Near complete resolution of COVID-19 pneumonia lesions in a patient of carcinoma lung treated with volumetric modulated arc therapy

Abstract

A 49-year-old male presented with non-small cell lung cancer in right upper lobe lung with solitary brain metastasis. He developed COVID-19 infection and received domiciliary treatment for 3 weeks. Three weeks after testing negative for RT-PCR test, he received stereotactic radiosurgery (SRS) to brain metastasis. He then presented in emergency with pain in the epigastrium and was detected with amoebic liver abscess. Subsequently, he developed recurrent hemoptysis for which he was planned for palliative radiation to right lung mass. Planning CT scan showed COVID-19 pneumonia lesions involving bilateral lungs in addition to right upper lobe tumour. Palliative radiation 8 Gy/1 fraction was delivered to lung tumour with VMAT technique. He showed near total resolution of COVID-19 lesions with low-dose scatter radiation and relief of haemoptysis.

Figure 1.

A HRCT scan chest done on 21 November 2020 showed right sided primary lung tumour and bilateral COVID-19 lung lesions (CT-SS 14/25); (B) It shows radiation dose distribution around primary lung lesion (Gross tumour volume +5 mm PTV) and low-dose radiation spillage in bilateral lungs. Right-sided upper lobe lesion received palliative radiation – 8 Gy/1 fraction with volumetric modulated arc therapy (VMAT). [Green colour represents (D₉₅) (7.6 Gy) of 8 Gy delivered to primary lung lesion; Low-dose radiation spillage is represented by dark blue 2 Gy isodose; cyan 1 Gy and pink 0.50 Gy, yellow 0.25 Gy and magenta 0.13 Gy in different areas of both the lungs]; (C,) 1-week post-radiation therapy response in bilateral COVID lung lesions attributed to low-dose radiation spillage and CT-SS score declining to 3/25.