COVID-19 pneumonia treated with ultra-low doses of radiotherapy (ULTRA-COVID study): a single institution report of two cases

Elena Moreno-Olmedo, Vladimir Suárez-Gironzini, Manuel Pérez, Teresa Filigheddu, Cristina Mínguez, Alba Sanjuan-Sanjuan, José A González, Daniel Rivas, Luis Gorospe, Luis Larrea, Escarlata López, Elena Moreno-Olmedo, Vladimir Suárez-Gironzini, Manuel Pérez, Teresa Filigheddu, Cristina Mínguez, Alba Sanjuan-Sanjuan, José A González, Daniel Rivas, Luis Gorospe, Luis Larrea, Escarlata López

Abstract

Introduction: Since the outbreak of coronavirus disease 2019 (COVID-19) pandemic, healthcare systems have focused their efforts into finding a treatment to avoid the fatal outcomes of severe acute respiratory syndrome due to coronavirus‑2 (SARS-CoV-2). Benefits and risks of systemic treatments remain unclear, with multiple clinical trials still ongoing. Radiotherapy could play a role in reducing the inflammatory response in the lungs and relieve life-threatening symptoms.

Methods: We designed a prospective study of Ultra-Low Doses of Therapy with Radiation Applied to COVID-19 (ULTRA-COVID) for patients who suffer pneumonia, are not candidates for invasive mechanical ventilation and show no improvement with medical therapy.

Results: We present the preliminary results of two patients diagnosed with COVID-19 pneumonia treated with ULTRA-COVID. After one radiotherapy session, significant clinical response and a good radiological response was observed in both cases, resulting in both patients being discharged from hospital in less than 2 weeks after radiation treatment.

Conclusion: Preliminary clinical and radiological results suggest a potential benefit of treating COVID-19 pneumonia with ULTRA-COVID. ClinicalTrials.gov Identifier: NCT04394182.

Keywords: COVID-19 pneumonitis; Cytokine storm; Inflamatory response; Radiation; SARS-CoV-2.

Conflict of interest statement

E. Moreno-Olmedo, V. Suárez-Gironzini, M. Pérez, T. Filigheddu., C. Mínguez, A. Sanjuan-Sanjuan, J.A. González, D. Rivas, L. Gorospe, L. Larrea and E. López declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CT scan evaluation. Axial and coronal reconstructions of computed tomography (CT) scans for patient 1: a Baseline, b first follow-up 7 days after radiotherapy (RT), c second follow-up at month 1. Patient 2: d Baseline, e first follow-up 7 days after RT, f second follow-up at month 1

References

    1. Cuttler JM (2020). Letter to Dr. Stephen M Hahn. March 20, 2020. 10.13140/RG.2.2.19071.84646
    1. Dhawan G, Kapoor R, Dhawan R et al (2020) Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS). Radiother Oncol 147:212–216. 10.1016/j.radonc.2020.05.002
    1. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–1034. doi: 10.1016/S0140-6736(20)30628-0.
    1. Kirkby C, Mackenzie M (2020) Is low dose radiation therapy a potential treatment for COVID-19 pneumonia? Radiother Oncol 147:221. 10.1016/j.radonc.2020.04.004. Epub 2020 Apr 6. PMID: 32342871; PMCID: PMC7194710
    1. Chakrabarti D, Verma M. Low-dose radiotherapy for SARS-CoV-2 pneumonia. Strahlenther Onkol. 2020 doi: 10.1007/s00066-020-01634-8.
    1. Calabrese EJ, Dhawan G. How radiotherapy was historically used to treat pneumonia: could it be useful today? Yale J Biol Med. 2013;86:555–570.
    1. Torres Royo L, Antelo Redondo G, Arquez Pianetta M, et al. Low-dose radiation therapy for benign pathologies. Rep Pract Oncol Radiother. 2020;25:250–254. doi: 10.1016/j.rpor.2020.02.004.
    1. Schaue D, Jahns J, Hildebrandt G, et al. Radiation treatment of acute inflammation in mice. Int J Radiat Biol. 2005;81:657–667. doi: 10.1080/09553000500385556.
    1. Arenas M, Gil F, Gironella M, et al. Time course of anti-inflammatory effect of low-dose radiotherapy: correlation with tgf-beta (1) expression. Radiother Oncol. 2008;86:399–406. doi: 10.1016/j.radonc.2007.10.032.
    1. Rödel F, Keilholz L, Herrmann M, et al. Radiobilogical mechanisms in inflammatory diseases of low-dose radiation therapy. Int J Radiat Biol. 2007;83(6):357–366. doi: 10.1080/09553000701317358.
    1. Charlson ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5.
    1. WHO-China Joint Mission . Report of the WHO-China joint mission on Coronavirus disease 2019 (COVID-19) 2020.
    1. Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19) Eur Radiol. 2020 doi: 10.1007/s00330-020-06817-6.
    1. Oken M, Creech R, Tormey D, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–655. doi: 10.1097/00000421-198212000-00014.
    1. CTCAE v5.0 – November 27, 2017: . Accessed 27 Nov 2017
    1. Alzghari SK, Acuña VS. Supportive treatment with tocilizumab for COVID-19: a systematic review. J Clin Virol. 2020;127:104380. doi: 10.1016/j.jcv.2020.104380.
    1. Lara PC, et al. Low dose lung radiotherapy for COVID-19 pneumonia. The rationale for a cost-effective anti-inflammatory treatment. Clin Trans Radiat Oncol. 2020;23:27–29. doi: 10.1016/j.ctro.2020.04.006.
    1. U.S. National Library of Medicine. . Accessed 20 Oct 2020
    1. Rödel F, Arenas M, Ott OJ. Low-dose radiation therapy for COVID-19 pneumopathy: what is the evidence? Strahlenther Onkol. 2020 doi: 10.1007/s00066-020-01635-7.
    1. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020 doi: 10.1001/jama.2020.4031.
    1. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020 doi: 10.1016/S0140-6736(20)30627-9.
    1. . Accessed 3 Mar 2020
    1. Trott KR, Kamprad F. Estimation of cancer risks from radiotherapy of benign diseases. Strahlenther Onkol. 2006;182:431–436. doi: 10.1007/s00066-006-1542-8.
    1. Mckeown SR, Hatfield P, Prestwich RJD, et al. Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermidate dose radiation. Br J Radiol. 2015;88:20150405. doi: 10.1259/bjr.20150405.
    1. Mazonakis M, Damilakis J (2017) Cancer risk after radiotherapy for benign diseases. Phys Med (42):285–291. 10.1016/j.ejmp.2017.01.014. Epub 2017 Feb 8. PMID: 28189418
    1. Hess CB et al Low-dose whole-lung radiation for COVID-19 pneumonia: planned day‑7 interim analysis of a registered clinical trial. December 126(23):5109–5113. 10.1101/2020.06.03.20116988
    1. Channappanavar R, Perlman S. Pathogenichuman coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39:529–539. doi: 10.1007/s00281-017-0629-x.

Source: PubMed

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