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.
Keywords: COVID-19; SARS-CoV-2; radiotherapy; whole-lung irradiation.
【저자키워드】 COVID-19, SARS-CoV-2, Radiotherapy, whole-lung irradiation., 【초록키워드】 Respiratory failure, Mortality, Pneumonia, COVID-19 pandemic, severity, 28-day mortality, oxygen, X-ray, Shock, low-dose, Patient, Thromboembolism, death, chest X-ray, morbidity and mortality, change, COVID-19 patients, primary endpoint, dose, CXR, control group, Secondary endpoints, overall survival, Final, O2 Saturation, significantly lower, benefit, IMPROVE, caused, required, treated, determine, changes in, 24 hour, 【제목키워드】 severe COVID-19, Controlled clinical trial,