Elsevier

Advances in Radiation Oncology

Volume 5, Issue 4, July–August 2020, Pages 617-620
Advances in Radiation Oncology

Research Letter
Need for Caution in the Diagnosis of Radiation Pneumonitis During the COVID-19 Pandemic

https://doi.org/10.1016/j.adro.2020.04.015Get rights and content
Under a Creative Commons license
open access

Abstract

Purpose

Patients with cancer are at high risk for mortality from coronavirus disease 2019 (COVID-19). Radiation pneumonitis (RP) is a common toxicity of thoracic radiation therapy with clinical and imaging features that overlap with those of COVID-19; however, RP is treated with high-dose corticosteroids, which may exacerbate COVID-19–associated lung injury. We reviewed patients who presented with symptoms of RP during the intensification of a regional COVID-19 epidemic to report on their clinical course and COVID-19 testing results.

Methods and Materials

The clinical course and chest computed tomography (CT) imaging findings of consecutive patients who presented with symptoms of RP in March 2020 were reviewed. The first regional COVID-19 case was diagnosed on March 1, 2020. All patients underwent COVID-19 qualitative RNA testing.

Results

Four patients with clinical suspicion for RP were assessed. Three out of 4 patients tested positive for COVID-19. All patients presented with symptoms of cough and dyspnea. Two patients had a fever, of whom only 1 tested positive for COVID-19. Two patients started on an empirical high-dose corticosteroid taper for presumed RP, but both had clinical deterioration and ultimately tested positive for COVID-19 and required hospitalization. Chest CT findings in patients suspected of RP but ultimately diagnosed with COVID-19 showed ground-glass opacities mostly pronounced outside the radiation field.

Conclusions

As this pandemic continues, patients with symptoms of RP require diagnostic attention. We recommend that patients suspected of RP be tested for COVID-19 before starting empirical corticosteroids and for careful attention to be paid to chest CT imaging to prevent potential exacerbation of COVID-19 in these high-risk patients.

Cited by (0)

Sources of support: MSKCC Cancer Center Support Grant, Principal Investigator (Thompson). Agency: NIH/NCI, 5 P30 CA008748-54.

Disclosures: N.S. has research funding from Novartis. A.S. was reimbursed for travel and consulting by ASCO. A.R. is a consultant for AstraZeneca, Varian Medical Systems, Merck, Cybrexa, and MoreHealth, has research grants from AstraZeneca, Varian Medical Systems, Boehringer Ingelheim, Pfizer, and Merck, and has received travel reimbursement from Philips/Elekta and Research to Practice. A.J.W. received research grants from CivaTech Oncology, is a consultant for AstraZeneca, and has received honoraria (travel grant) from AlphaTau Medical. C.B.S. has received a Varian Medical Systems honorarium. D.R.G. received research grants from Boehringer-Ingelheim, Varian Medical systems, AstraZeneca, Merck, and Bristol Myers Squibb and personal fees from Varian Medical systems, AstraZeneca, Merck, and Bristol Myers Squibb.

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N.S. and A.S. contributed equally to this article. D.Y.G. is a cosenior author.