Whole lung Irradiation as a Novel treatment for COVID-19: Interim Results of an Ongoing Phase 2 trial in India

Govindaraj, G.; Sasipriya, P.; Sundaram, Vivek; Praveen Kumar, M.; Venkatraman, P.; Manigandan, C.; Janakiraman, T.; Gunasekaran, K.; Prabhu, R.; Brindha, T.; Shree Vaishnavi, R.

Background and Purpose The main cause of death in COVID-19 pneumonia is acute respiratory distress syndrome which is preceded by massive cytokine release. Low-dose radiation therapy (LDRT) has anti-inflammatory and immunomodulatory effects that can interfere with the inflammatory cascade, reducing the severity of associated cytokine release. Material & Methods 25 patients with RT-PCR proven COVID-19 disease were enrolled between November 2020 and May 2021. All patients had SpO2 < 94% on room air, respiratory frequency > 24/min and SpO2/FiO2 ratio (SF ratio) of >89 but < 357. Patients were treated according to standard COVID-19 management guidelines along with single fraction LDRT of 0.5Gy to bilateral whole lungs within 10 days of symptom onset and 5 days of hospital admission. Results LDRT was well tolerated by all patients. There was a statistically significant improvement in oxygenation as given by the SF ratio between pre-RT and day 2 (p<0.05), day 3 (p<0.001) and day 7 (p<0.001) post RT. Demand for supplemental oxygen showed statistically significant reduction between pre-RT and day 2 (p<0.05), day 3 (p<0.001), day 7 (p<0.001) post RT. 88% patients attained clinical recovery within 10 days post LDRT and median time to hospital discharge from day of LDRT was 6 days. Three patients deteriorated and died. Conclusion As per our initial experience, LDRT appears to be a promising modality of treatment with rapid relief of respiratory distress in selected patients with moderate to severe COVID-19 pneumonia. This translates to early clinical recovery and hospital discharge in the selected patient group.