Low-Dose Whole-Lung Irradiation in Severe Covid-19 Pneumonia: A Controlled Clinical Trial Publisher Pubmed



Mousavi Darzikolaee N^{1, 2} ; Kolahdouzan K^{1, 2} ; Abtahi H³ ; Kazemizadeh H^{3, 4} ; Salehi M⁵ ; Ghalehtaki R^{1, 2} ; Bayani R^{1, 2} ; Pestehei SK⁶ ; Ghazanfari T⁷ ; Ebrahiminasab F¹ ; Salarvand S⁸ ; Haddad P² ; Kazemian A^{1, 2} ; Aghili M^{1, 2} Show Affiliations
Source: Journal of Medical Radiation Sciences Published:2021

Abstract

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 study's 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. © 2021 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology