Purpose
Studies dating back to a century ago have reported using low-dose radiation therapy for the treatment of viral and bacterial pneumonia. In the modern era, since the COVID-19 pandemic began, several groups worldwide have researched the applicability of whole lung irradiation (WLI) for the treatment of COVID-19. We aimed to bring together the results of these experimental studies.
Methods and Materials
We performed a systematic review and meta-analysis searching PubMed and Scopus databases for clinical trials incorporating WLI for the treatment of patients with COVID-19. Required data were extracted from each study. Using the random-effects model, the overall pooled day 28 survival rate, survival hazard ratio, and intubation-free days within 15 days after WLI were calculated, and forest plots were produced.
Results
Ten studies were identified, and eventually, 5 were included for meta-analysis. The overall survival hazard ratio was calculated to be 0.85 (0.46-1.57). The pooled mean difference of intubation-free days within 15 days after WLI was 1.87, favoring the WLI group (95% confidence interval, –0.02 to 3.76). The overall day 28 survival rate of patients receiving WLI for the 9 studies with adequate follow-up data was 74% (95% confidence interval, 61-87). Except for 2 studies, the other 8 studies were assessed to have moderate to high risk of bias, and there were many differences among the designs of the studies, included patients, primary endpoints, outcome measurement methods, and reporting of the results.
Conclusions
Despite a mild improvement in intubation-free days, WLI had no significant effect on patients’ overall survival. Currently, we cannot recommend routine use of WLI for the treatment of patients with moderate-to-severe COVID-19.
【초록키워드】 COVID-19, Treatment, Meta-analysis, clinical trial, Pneumonia, COVID-19 pandemic, lung, systematic review, outcome, database, survival, low-dose, Patient, Mild, Follow-up, survival rate, group, moderate, patients, Bacterial, radiation therapy, high risk, forest plot, significant effect, 95% confidence interval, primary endpoints, moderate-to-severe COVID-19, hazard ratio, mean difference, random-effects model, material, applicability, Result, produced, performed, reported, receiving, calculated, had no, patients with COVID-19, were assessed, 【제목키워드】 COVID-19, review, irradiation,