X-out COVID-19.

Top Line: Is it time to use whole lung radiation for severe COVID-19 pneumonia?

The Studies: Back in April, there was chatter about using low-dose whole lung radiation to reduce the inflammatory response in critically ill patients with COVID-19 pneumonia, and several trial protocols were formulated. Here are two small studies reporting outcomes for such an approach. The first, from Iran, enrolled 5 (out of 40 invited) patients over age 60 who were hospitalized and requiring oxygen for COVID-19 pneumonia. In addition to standard-of-care treatment (sans dexamethasone, hydroxychloroquine, or remdesivir), they received 0.5 Gy x 1 whole lung radiation. One patient died, but the rest clinically improved shortly after radiation and there was no acute toxicity. The second, from Emory, is a preprint of the (cue Shatner voice-over) RESCUE 1-19 trial. The 10 enrolled patients had COVID-19 pneumonia and were declining clinically on supplemental oxygen. This trial gave 1.5 Gy x 1 whole lung radiation. They compared outcomes to a matched cohort of patients hospitalized and enrolled in different protocols during the same time period. Remembering there were only 10 patients, those who had radiation had a shorter time to clinical recovery and a lower rate of intubation. There was no acute toxicity.

TBL: These small trials of low-dose, whole lung radiation provide safety and efficacy data to support larger trials for COVID-19 pneumonia. | Ameri, Int J Radiat Oncol Biol Phys 2020 and Hess, medRxiv 2020