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

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 disease 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 0.5Gy 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.

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].…”

Low-Dose Radiotherapy for Patients with Pneumonia Due to COVID-19: A Single-Institution Prospective Study

“…Eighty-eight percent of patients attained clinical recovery within 10 days after LDRT. No acute toxicity was found in this study either [ 25 ].…”

Low-dose Radiation Therapy in the Management of COVID-19 Pneumonia (LOWRAD-Cov19). Final results of a prospective phase I–II trial

“…Our respiratory results are in agreement with previous published data. [22] , [23] , [24] Ameri et al [6] analyzed 9 patients treated with 0.5 or 1 Gy and found a SatO2 improvement in 64% of them 24 hours after RT. In our cohort there was significant SAFI improvement on day +3 and day +7 (p<0.01).…”