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Short Report
Low-dose Whole-lung Irradiation for COVID-19 Pneumonia: Short Course Results
Nazanin Rahnama
Department of Clinical Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- This study reports on a clinical trial.
- The author has confirmed that this trial has been registered with an ICMJE-approved registry, and the trial registration ID has been provided in the text. If the article reports on a study that was registered retrospectively, a statement explaining why the study was not registered in advance has been provided in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
Objectives: The COVID-19 outbreak is affecting people worldwide. Most of the infected patients suffering from respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiotherapy in patients with COVID-19 pneumonia.
Methods: In this clinical trial, done in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (IL-6 and CRP) were recorded before and after irradiation.
Results: Between 21 May 2020 and 24 June 2020, five patients received whole-lung irradiation. They followed for 5-7 days to evaluate response to treatment and toxicities. The clinical and paraclinical findings of four patients (except for patient #4 that get worst and died on day 3) improved on the first day of irradiation. Patient #3 opted-out the trial on the third day of irradiation. The mean time to discharge was 6 days for the other three patients. No acute radiation-induced toxicity was recorded.
Conclusion: With a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia.
Keywords
COVID-19, Pneumonia, Low dose radiotherapy, Lung
Figure 1
SMJ Mortazavi
ORCiDcommented on 09 July, 2020
There are many questions about the methods used in this study. Moreover, it is not justified at all that the authors state "Given the encouraging results of this pilot trial, the Ethical Committee of Shahid Beheshti University of Medical Sciences allowed continuing the trial using 1.0 Gy whole-lune irradiation". How did they come to this conclusion that higher doses might be more effective? The concept of using low dose radiation for treatment of COVID_19 associated pneumonia was first introduced by our team in March 2020. The doses suggested by our team were less than 250 mGy ( DOI: 10.31661/JBPE.V0I0.2003-1085). Given this consideration, we believe that if the authors had used lower doses, they would have more promising results.
View 1 reply
SMJ Mortazavi
ORCiDcommented on 09 July, 2020
There are many questions about the methods used in this study. Moreover, it is not justified at all that the authors state "Given the encouraging results of this pilot trial, the Ethical Committee of Shahid Beheshti University of Medical Sciences allowed continuing the trial using 1.0 Gy whole-lune irradiation". How did they come to this conclusion that higher doses might be more effective? The concept of using low dose radiation for treatment of COVID_19 associated pneumonia was first introduced by our team in March 2020. The doses suggested by our team were less than 250 mGy ( DOI: 10.31661/JBPE.V0I0.2003-1085). Given this consideration, we believe that if the authors had used lower doses, they would have more promising results.
Mohan Doss
commented on 09 July, 2020
The results are encouraging. The authors reported that 4 out of 5 patients recovered with the low-dose radiation treatments. Can the authors indicate what fraction of equivalent patients in their institution recovered following other treatments, from recent hospital data? Thanks.
SMJ Mortazavi
ORCiDcommented on 09 July, 2020
@Mohan Doss Thank you for your thoughtful comment! As you know, the preliminary findings of Emory University Hospital's trial have previously been published. In their trial, a single treatment of low-dose (1.5 Gy) irradiation of both lungs was administered after a 72-hour wait while hospitalized. Again, 4 of the 5 patients greatly benefited from the LDRT. I am among the scientists who believe if the dose had been lower and the waiting time for the radiation therapy had been shorter (e.g., 24 hours) all of the 5 patients may have benefited from the therapy. Clinical trials started by other groups involved radiation doses less than 1 Gy.
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This is a preprint. It has not completed peer review.
Short Report
Low-dose Whole-lung Irradiation for COVID-19 Pneumonia: Short Course Results
Nazanin Rahnama
Department of Clinical Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 07 Jul, 2020
Community comments: 5
Metrics
Comments: 5
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- This study reports on a clinical trial.
- The author has confirmed that this trial has been registered with an ICMJE-approved registry, and the trial registration ID has been provided in the text. If the article reports on a study that was registered retrospectively, a statement explaining why the study was not registered in advance has been provided in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
Objectives: The COVID-19 outbreak is affecting people worldwide. Most of the infected patients suffering from respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiotherapy in patients with COVID-19 pneumonia.
Methods: In this clinical trial, done in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (IL-6 and CRP) were recorded before and after irradiation.
Results: Between 21 May 2020 and 24 June 2020, five patients received whole-lung irradiation. They followed for 5-7 days to evaluate response to treatment and toxicities. The clinical and paraclinical findings of four patients (except for patient #4 that get worst and died on day 3) improved on the first day of irradiation. Patient #3 opted-out the trial on the third day of irradiation. The mean time to discharge was 6 days for the other three patients. No acute radiation-induced toxicity was recorded.
Conclusion: With a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia.
Figure 1
SMJ Mortazavi
ORCiDcommented on 09 July, 2020
There are many questions about the methods used in this study. Moreover, it is not justified at all that the authors state "Given the encouraging results of this pilot trial, the Ethical Committee of Shahid Beheshti University of Medical Sciences allowed continuing the trial using 1.0 Gy whole-lune irradiation". How did they come to this conclusion that higher doses might be more effective? The concept of using low dose radiation for treatment of COVID_19 associated pneumonia was first introduced by our team in March 2020. The doses suggested by our team were less than 250 mGy ( DOI: 10.31661/JBPE.V0I0.2003-1085). Given this consideration, we believe that if the authors had used lower doses, they would have more promising results.
View 1 reply
Vincent Paglioni
ORCiDreplied on 09 July, 2020
Thank you for linking your research. I agree, there are several shortcomings of this pilot study that need to be addressed in the full experiment. For instance (I have no experience in medicine) - is it common to admit patients into a COVID-19 related trial that were not tested via PCR? It seems like the authors are looking to the previous studies with larger doses (0.7 - 1.0 Gy) and attempting to validate those results with this study, which would normally be a fine effort. However, this seems to be in contradiction with their stated purpose of investigating lower doses - should not the next step be to lower the administered dose below 0.5 Gy?
SMJ Mortazavi
ORCiDcommented on 09 July, 2020
There are many questions about the methods used in this study. Moreover, it is not justified at all that the authors state "Given the encouraging results of this pilot trial, the Ethical Committee of Shahid Beheshti University of Medical Sciences allowed continuing the trial using 1.0 Gy whole-lune irradiation". How did they come to this conclusion that higher doses might be more effective? The concept of using low dose radiation for treatment of COVID_19 associated pneumonia was first introduced by our team in March 2020. The doses suggested by our team were less than 250 mGy ( DOI: 10.31661/JBPE.V0I0.2003-1085). Given this consideration, we believe that if the authors had used lower doses, they would have more promising results.
Mohan Doss
commented on 09 July, 2020
The results are encouraging. The authors reported that 4 out of 5 patients recovered with the low-dose radiation treatments. Can the authors indicate what fraction of equivalent patients in their institution recovered following other treatments, from recent hospital data? Thanks.
SMJ Mortazavi
ORCiDcommented on 09 July, 2020
@Mohan Doss Thank you for your thoughtful comment! As you know, the preliminary findings of Emory University Hospital's trial have previously been published. In their trial, a single treatment of low-dose (1.5 Gy) irradiation of both lungs was administered after a 72-hour wait while hospitalized. Again, 4 of the 5 patients greatly benefited from the LDRT. I am among the scientists who believe if the dose had been lower and the waiting time for the radiation therapy had been shorter (e.g., 24 hours) all of the 5 patients may have benefited from the therapy. Clinical trials started by other groups involved radiation doses less than 1 Gy.
Vincent Paglioni
ORCiDreplied on 09 July, 2020
Thank you for linking your research. I agree, there are several shortcomings of this pilot study that need to be addressed in the full experiment. For instance (I have no experience in medicine) - is it common to admit patients into a COVID-19 related trial that were not tested via PCR? It seems like the authors are looking to the previous studies with larger doses (0.7 - 1.0 Gy) and attempting to validate those results with this study, which would normally be a fine effort. However, this seems to be in contradiction with their stated purpose of investigating lower doses - should not the next step be to lower the administered dose below 0.5 Gy?