Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS)

Dhawan, Gaurav; Kapoor, Rachna; Dhawan, Rajiv; Singh, Ravinder; Monga, Bharat; Giordano, James; Calabrese, Edward J.

doi:10.1016/j.radonc.2020.05.002

Cited by 97 publications

(102 citation statements)

References 41 publications

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“…The use of RT could stop the progression to an advance stage of the disease; and this could help curb down the death rates, now 3.4% on average, and higher among elder and ICU patients (21). The optimal dose of RT is unknown with evidence supporting 0.5-1Gy (2,4,5). The average prescription doses of the ongoing trials are 0.5 and 0.7 Gy in a single dose and; optionally, an additional 0.5 Gy fraction 48h later.…”

Section: Discussionmentioning

confidence: 99%

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Early results of COVID-19 pneumonia cases treated with Ultra-Low doses of Radiotherapy (ULTRA-COVID study)

Moreno-Olmedo¹,

Suarez-Gironzini²,

Pérez³

et al. 2020

Preprint

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Introduction:Since the outbreak of COVID-19 pandemic, healthcare system has focused its effort to find a treatment to avoid the fatal outcome of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Benefits and risks of systemic treatments are unclear. Radiotherapy could play a role in reducing the inflammatory response in the lungs and relieve life-threatening symptomsMethods:We designed a prospective study of Ultra-Low-Doses of Therapy with Radiation Applied to COVID-19 (ULTRA-COVID) for patients that are no candidates for invasive mechanical ventilation and show no improvement with medical therapy. (ClinicalTrials.gov Identifier: NCT04394182)Results:We present the preliminary results of two patients diagnosed with COVID-19 pneumonia treated with ULTRA-COVID. Significant clinical response is accompanied by lower radiological one, both have happened, achieving hospital discharge after 1 radiotherapy session over a period of 8 and 14 days, respectively.Conclusion:Preliminary clinical and radiological results suggest a potential benefit of treating COVID-19 pneumonia with ultra-LDRT.

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Section: Discussionmentioning

confidence: 99%

“…Although most part of COVID-19 patients will be asymptomatic, complications such as severe pneumonia, respiratory failure, or acute respiratory distress syndrome (ARDS) can occur, leading to fatal consequences. Most of the time, these cases require of intensive care unit (ICU) admission and invasive mechanical ventilator (IMV) (2).…”

Section: Introductionmentioning

confidence: 99%

Early results of COVID-19 pneumonia cases treated with Ultra-Low doses of Radiotherapy (ULTRA-COVID study)

Moreno-Olmedo¹,

Suarez-Gironzini²,

Pérez³

et al. 2020

Preprint

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“…In the early 20th century, viral and bacterial pneumonia patients were treated with radiotherapy to deliver lung doses of 0.3 to 1.0 Gy using 100 to 200 kV p x-ray beams. [1][2][3][4][5] This was a https://doi.org/10.1016/j.meddos.2020.08.002 0958-3947/© 2020 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.…”

Section: Introductionmentioning

confidence: 99%

Dose simulations of an early 20th century kilovoltage pneumonia radiotherapy technique performed with a modern fluoroscope

et al. 2021

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To simulate an early 20th century viral pneumonia radiotherapy treatment using modern fluoroscopy and evaluated it according to current dose guidelines. Monte Carlo was used to assess the dose distribution on an anthropomorphic phantom. Critical organs were: skin, breasts, esophagus, ribs, vertebrae, heart, thymus, and spinal cord. A 100 kV p beam with 3 mm Al HVL, 25 × 25 cm 2 posterior-anterior (PA) field and 50 cm source-to-surface distance were simulated. Simulations had a resolution of 0.4 × 0.4 × 0.06 cm 3 and a 6% uncertainty. Hundred percent dose was normalized to the skin surface and results were displayed in axial, coronal, and sagittal planes. Dose volume histograms were generated in MATLAB for further analysis. Prescription doses of 0.3, 0.5, and 1.0 Gy were applied to the 15% isodose for organ-dose comparison to current tolerances and potential risk of detriment. Ninety-five and ninety-seven percent of the right and left lung volumes, respectively, were well-covered by the 15% isodose line. For the 0.3, 0.5, and 1.0 Gy prescriptions, the maximum skin doses were 2.9, 4.8, and 9.6 Gy compared to a 2.0 Gy transient erythema dose threshold; left/right lung maximum doses were 1.44/1.46, 2.4/2.4, and 4.8/4.9 Gy compared to a 6.5 Gy pneumonitis and 30 Gy fibrosis thresholds; maximum heart doses were 0.5, 0.9, and 1.8 Gy compared to the 0.5 Gy ICRP-recommendation; maximum spinal cord doses were 1.4, 2.3, and 4.6 Gy compared to 7.0 Gy single fraction dose threshold. Maximum doses to other critical organs were below modern dose thresholds. A 100 kV p PA field could deliver a 0.3 Gy or 0.5 Gy dose without risk of complications. However, a 1.0 Gy dose treatment could be problematic. Critical organ doses could be further reduced if more than one treatment field is used.

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“…LDRT is known to induce an antiinflammatory phenotype that results in rapid amelioration of the systemic inflammatory cascade, while avoiding long-term adverse effects. 13 Several clinical trials are currently underway across the globe to elicit the beneficial effects of LDRT. 14 Computerized tomography (CT) scan is a clinical procedure with high sensitivity and specificity for the diagnosis and determination of pulmonary lesions in patients infected with the COVID-coronavirus.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Treatment Planning System in Localizing the COVID-19 Pneumonia Lesions and Evaluation of Volume Indices of Lung Involvement

et al. 2020

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Background and purpose: To assess the feasibility of a treatment planning system in localizing, contouring, and targeting lung lesions along with an evaluation of volume indices of lung involvement in patients with COVID-19 pneumonia. Methods: We evaluated 10 patients with PCR-confirmed COVID-19 pneumonia. The CT images were imported into the ISOgray® treatment planning system to anatomically define and contour the volumes of the pulmonary lesions, the lungs, and other nearby organs. Results: The ratio of lung lesion volume to lung volume in this study was 0.11 ± 0.13 (11.13%). The highest mean biosynthesis ratio of lung lesions was 0.36. The ratio of lesion volume in the left lung of patients with the highest volume of involvement, was 0.44, and the ratio of lesion volume in the right lung of these patients was 0.27 (approximately 1.5 times more in the left lung than the right lung). On average, CTDIvol and DLP for all patients studied in our study were 11.22 ± 2.47 mGy and 354.20 ± 65.11 mGy.cm Conclusion: We reported the feasibility of using a treatment planning system in localizing COVID-19 pulmonary lesions and its validity in the volumetric assessment of infected lung regions.

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Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS)

Cited by 97 publications

References 41 publications

Early results of COVID-19 pneumonia cases treated with Ultra-Low doses of Radiotherapy (ULTRA-COVID study)

Early results of COVID-19 pneumonia cases treated with Ultra-Low doses of Radiotherapy (ULTRA-COVID study)

Dose simulations of an early 20th century kilovoltage pneumonia radiotherapy technique performed with a modern fluoroscope

Feasibility of Treatment Planning System in Localizing the COVID-19 Pneumonia Lesions and Evaluation of Volume Indices of Lung Involvement

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