Low-Dose Whole-Lung Radiation for COVID-19 Pneumonia: Planned Day-7 Interim Analysis of an Ongoing Clinical Trial
Abstract
Background
Individuals with advanced age and comorbidities face higher risk of death from COVID-19, especially once ventilator-dependent. Respiratory decline in COVID-19 is mediated by a pneumonic aberrant immune cytokine storm. Low-dose radiation was used to treat pneumonia in the pre-antibiotic era. Radiation immunomodulatory effects may improve outcomes in COVID-19.
Methods
We performed a single-institution phase I/II trial evaluating the safety and efficacy of single-fraction, low-dose, whole-lung radiation for COVID-19 pneumonia. Eligible patients were hospitalized, had radiographic pneumonic infiltrates, required supplemental oxygen, and were clinically deteriorating.
Results
Of nine patients screened, five were treated with whole-lung radiation from April 2328, 2020 and followed for 7 days. Median age was 90 (range 64-94); four were nursing home residents with multiple comorbidities. Within 24 hours of radiation, three patients (60%) weaned from supplemental oxygen to ambient air, four (80%) exhibited radiographic improvement, and median Glasgow coma score improved from 10 to 14. A fourth patient (80% overall recovery) weaned from oxygen at hour 96. Mean time to clinical recovery was 35 hours. There were no acute skin, pulmonary, GI, GU toxicities.
Conclusions
In a small pilot trial of five oxygen-dependent patients with COVID-19 pneumonia, low-dose whole-lung radiation led to rapid improvement in clinical status, encephalopathy, and radiographic infiltrates without acute toxicity or worsening the cytokine storm. Low-dose whole-lung radiation appears to be safe, shows early promise of efficacy, and warrants larger prospective trials.
Lay Summary
Researchers at Emory University have completed treatment of cohort 1 of a pilot trial of low-dose lung irradiation for COVID-19 pneumonia. Five residents of nursing or group homes with COVID-19 outbreaks were hospitalized after testing positive for COVID-19. Each had pneumonia visible on chest x-ray, required supplemental oxygen, and had clinically declined. A single treatment of low-dose (1.5 Gy) radiation to both lungs was delivered over 10-15 minutes. Within 24 hours, four patients rapidly improved their breathing, recovering at an average of 1.5 days (range 3 to 96 hours), and had either been discharged (three) or were preparing for discharge (one) by day 14. Blood tests and repeat imaging confirmed that low-dose radiation appeared safe and effective in reducing their COVID-19 symptoms. Further trials are warranted.
Related articles
Related articles are currently not available for this article.