Whole lung irradiation as a novel treatment for COVID-19: Final results of the prospective randomized trial (WINCOVID trial)

Abstract

Background and Purpose The ability of Low dose radiotherapy (LDRT) to control the unprecedented cytokine release associated with COVID-19 pathogenesis has been an area of widespread research since the COVID pandemic. It has not been studied adequately whether the anti-inflammatory effect of LDRT provides additional benefit when used concurrently with steroids amongst other standard pharmacologic therapy. Material and Methods 51 RT-PCR positive COVID-19 patients were recruited between November 2020 and July 2021. 34 patients were allotted to receive 0.5Gy single session LDRT along with standard pharmacologic therapy while 17 patients received standard pharmacologic therapy alone. All had SpO2<94% on room air, respiratory frequency > 24/min and SpO2/FiO2 (SF) ratio between >89 but <357. All patients underwent a baseline CT scan. They were followed up for 28 days during when serial SF ratio, blood biomarkers (CRP, Serum ferritin, IL-6), Absolute lymphocyte count (ALC), repeat CT scan were performed at pre-defined time points. Results LDRT showed a statistically significant early improvement in oxygenation, an early time to clinical recovery, early hospital discharge and better radiological resolution compared to control group. There was no statistically significant difference between the two groups with respect to ALC or blood biomarkers at any of the measured time points. The 28-day mortality rate did not show statistically significant difference between the two groups. Conclusion LDRT can be considered for selected oxygen-dependent moderate to severe COVID-19 patients for rapid relief of respiratory distress. It can be safely combined with standard pharmacologic treatment in such patients for added clinical benefit.

Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

“…Observations from these studies indicate that Low-dose radiotherapy (LDRT) for Covid-19 pneumonia delivers doses between 0.3 and 1 Gy. LDRT does not decrease the viability of virus directly, but it may increase the effectiveness of antiviral immune responses in the early/medium stages of SARS-CoV‑2 infection [ 141 , 146 , 151 , 164 , 167 , 171 , 177 , 179 ].…”

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

“…Many clinical studies have since evaluated the role of LDRT to lungs in COVID-19 pneumonia. Most of them are single arm studies and have documented feasibility, tolerability, and clinical benefit ( 16 , 21 , 22 ). However few studies such as that of Papachristofilou et al.…”

Low-Dose Whole Lung Irradiation for Treatment of COVID-19 Pneumonia: A Systematic Review and Meta-Analysis

“…One study was suspected of having provided incorrect results due to discrepancy between methodological analysis, reported results, and illustrated OS figures and was therefore removed from the meta-analysis 12 ; however, the presented results are discussed separately. Finally, 9 studies (with a total of 151 WLI recipients) were considered eligible to enter the analysis of aggregated 28-day OS rate of patients receiving WLI [17][18][19][20][21][22][23][24][25] (quantitative analysis). Six studies had both intervention and control groups (115 participants in the intervention group and 98 participants as controls).…”

“…Six studies had both intervention and control groups (115 participants in the intervention group and 98 participants as controls). 12,17,[20][21][22][23] One of these controlled studies was the excluded study due to erroneously reported results. Eventually, 4 studies were included for meta-analysis of intubation-free days within 15 days after WLI and 5 studies for meta-analysis of OS HR.…”