Low?dose whole?lung irradiation in severe COVID?19 pneumonia: a controlled clinical trial

Nima Mousavi Darzikolaee | Kasra Kolahdouzan | Hamidreza Abtahi | Hossein Kazemizadeh | Mohammadreza Salehi | Reza Ghalehtaki | Reyhaneh Bayani | Seyed Khalil Pestehei | Tooba Ghazanfari | Fatemeh Ebrahiminasab | Samaneh Salarvand | Peiman Haddad | Ali Kazemian | Mahdi Aghili

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URL :   http://research.shahed.ac.ir/WSR/WebPages/Report/PaperView.aspx?PaperID=158906
Date :  2021/07/23
Publish in :    Journal of Medical Radiation Sciences
DOI :  https://doi.org/ 10.1002/jmrs.542
Link :  http://dx.doi.org/ 10.1002/jmrs.542
Keywords : COVID-19; SARS-CoV-2; radiotherapy; whole-lung irradiation.

Abstract :

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Introduction: The COVID-19 pandemic has caused significant morbidity and mortality thus far. Considering the historical uses of high-voltage X-ray beams for unresolvable pneumonia, we aimed to assess whether low-dose whole-lung irradiation (WLI) could provide any benefits for patients with refractory COVID-19 pneumonia. Methods: Eleven patients with refractory COVID-19 pneumonia were treated with WLI to a total dose of 1 Gy and compared to 11 patients in a matched control group from June to November 2020. The studys primary endpoint was improvement of chest X-ray severity score (CXRS), followed by changes in mean oxygen (O2) saturation and 28-day mortality as secondary endpoints. Results: The final CXRS was significantly lower in the WLI group (8.7 ± 2.5) compared to the control group (12.3 ± 3.3) (P: 0.016). Change of CXRS from the first to the last chest X-ray was -2.2 ± 3.1 for the WLI group and 0.7 ± 3.9 for the control group, which showed a trend for lower CXRS in the WLI group (U = 30, p: 0.085). Mean O2 saturation showed insignificant improvement in the first 24 hours after radiotherapy (mean difference: 2.5 ± 4.1, Z=-1.6, P value: 0.11). Overall survival after 28 days was 32 in the WLI group and 11 in the control group (P: 0.48). The reason for death in many patients was not merely respiratory failure, but also other adverse situations like pneumothorax, cardiogenic shock and pulmonary thromboembolism. Conclusions: Low-dose WLI could improve the CXR severity score and O2 saturation in severely ill COVID-19 patients, but larger studies are required to determine its impact on mortality.