Interim Analysis of Impact of Adding Low Dose Pulmonary Radiotherapy to Moderate COVID-19 Pneumonia Patients: IMpaCt-RT Study

Abstract

BackgroundTreatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease.MethodsPatients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities.FindingsAt the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups.InterpretationLDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia.FundingAn intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India.Clinical Trial RegistrationClinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php

SARS-CoV-2 Serum Viral Load and Prognostic Markers Proposal for COVID-19 Pneumonia in Low-Dose Radiation Therapy Treated Patients

“…LDRT showed real curative benefits in the management of a variety of clinical conditions in which inflammation plays an important role, such as epicondylitis [15], osteoarthritis [16], necrotizing abscesses [17], and pneumonia. Several studies show that LDRT improves respiratory parameters and lung involvement and reduces serum inflammation markers [13,[18][19][20]. A comparative cohort study reported a reduction in mortality among moderate COVID-19 patients treated with LDRT compared to the control group [21].…”

Letter regarding “The clinical efficacy of low-dose whole-lung irradiation in moderate-to-severe COVID-19 pneumonia: RTMX-20 trial”

“…The authors conducted a prospective comparative cohort study to evaluate the clinical efficacy of LDWLI in moderate-to-severe COVID-19 pneumonia. We congratulate Ortiz et al for their inspiring conclusions and for having the largest sample size in this research [1] , [2] , [3] , [4] , [5] , [6] , [7] . However, some potential pitfalls should be addressed before we proceed with this evidence for clinical practice and research.…”

“…Low-dose whole-lung irradiation (LDWLI), a novel potential therapy of coronavirus disease 2019 (COVID-19) pneumonia, is a readily available modern medical resource worldwide [1] . Many clinical trials have been conducted to investigate the efficacy of LDWLI in reducing the COVID-19-related mortality risk [1] , [2] , [3] , [4] , [5] , [6] , [7] . As per our knowledge, the study published in the Green Journal by Ortiz et al [2] has the largest sample size among similar studies published to date [1] , [2] , [3] , [4] , [5] , [6] , [7] .…”

“…Many clinical trials have been conducted to investigate the efficacy of LDWLI in reducing the COVID-19-related mortality risk [1] , [2] , [3] , [4] , [5] , [6] , [7] . As per our knowledge, the study published in the Green Journal by Ortiz et al [2] has the largest sample size among similar studies published to date [1] , [2] , [3] , [4] , [5] , [6] , [7] . The authors conducted a prospective comparative cohort study to evaluate the clinical efficacy of LDWLI in moderate-to-severe COVID-19 pneumonia.…”

In Regard to Kolahdouzan et al.

“…We believe that addressing these issues would be beneficial to further enhance the value of the study. Moreover, several eligible and crucial studies have been published 7 , 8 , 9 , 10 that were not analyzed in the article. Therefore, a timely, updated meta-analysis should be carried out to provide more determinate evidence for decision making and for ongoing clinical trials.…”