Elsevier

Radiotherapy and Oncology

Volume 163, October 2021, Pages 83-90
Radiotherapy and Oncology

Original Article
Whole lung irradiation as a novel treatment for COVID-19: Interim results of an ongoing phase 2 trial in India

https://doi.org/10.1016/j.radonc.2021.08.001Get rights and content

Highlights

  • Low dose whole lung radiotherapy is a novel treatment under investigation for COVID19.

  • Suitable for hypoxic patients requiring O2 supplementation in early disease course.

  • 2/3rd reduction in supplemental O2 demand by 48h in majority of patients treated.

  • 88% of treated patients improved clinically; Discharged within 10 days of treatment.

  • LDRT has potential to prevent selected patients from deteriorating to critical stage.

Abstract

Background and purpose

The main cause of death in COVID-19 pneumonia is acute respiratory distress syndrome which is preceded by massive cytokine release. Low-dose radiation therapy (LDRT) has anti-inflammatory and immunomodulatory effects that can interfere with the inflammatory cascade, reducing the severity of associated cytokine release.

Material & methods

25 patients with RT-PCR proven COVID-19 pneumonia were enrolled between November 2020 and May 2021. All patients had SpO2 < 94 % on room air, respiratory frequency > 24/min and SpO2/FiO2 ratio (SF ratio) of >89 but <357. Patients were treated according to standard COVID-19 management guidelines along with single fraction LDRT of 0.5 Gy to bilateral whole lungs within 10 days of symptom onset and 5 days of hospital admission.

Results

LDRT was well tolerated by all patients. There was a statistically significant improvement in oxygenation as given by the SF ratio between pre-RT and day 2 (p < 0.05), day 3 (p < 0.001) and day 7 (p < 0.001) post RT. Demand for supplemental oxygen showed statistically significant reduction between pre-RT and day 2 (p < 0.05), day 3 (p < 0.001), day 7 (p < 0.001) post RT. 88 % patients attained clinical recovery within 10 days post LDRT and median time to hospital discharge from day of LDRT was 6 days. Three patients deteriorated and died.

Conclusion

As per our initial experience, LDRT appears to be a promising modality of treatment with rapid relief of respiratory distress in selected patients with moderate to severe COVID-19 pneumonia. This translates to early clinical recovery and hospital discharge in the selected patient group.

Keywords

Low dose radiotherapy
Immunomodulatory therapy
Anti-inflammatory therapy
COVID-19 therapy
Viral pneumonia
COVID-19 pneumonia

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