Brief Report: New Pulmonary Infiltrates Observed on Computed Tomography Based Image Guidance for Radiotherapy Warrant Diagnostic Workup for COVID-19.

Warren, Graham W.; Lim, Vun-Sin; Chowdhary, Mudit; Marwaha, Gaurav; Abd Elbadee, Osama Mostafa; Kirakli, Esra Korkmaz; Billiet, Charlotte; Marin, Alexandra Giraldo; Ramos, Monica; Suppli, Morten Hiul; McGinnis, Gwendolyn J.; Adjei, Alex A.

Introduction Screening for COVID-19 exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. Following two reported case studies of imaging findings during daily computed tomography (CT) -based image guided radiotherapy scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates seen during radiotherapy and COVID-19. We hereby report the results of the aggregate analysis. Methods Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during radiotherapy were submitted through an online portal. Information requested included a patient’s sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to demonstrate the presence or absence of ground glass opacities or infiltrates. Results A total of 7 reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States. Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of 9 patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction (PCR) based methods or nasopharyngeal swabs. Of the 9 patients analyzed, abnormalities consistent with ground glass opacities or infiltrates were observed in 8 patients. Conclusion This is the largest case series demonstrating the potential utility of CT-based image guidance during radiotherapy as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates, and immediate COVID-19 testing in patients who develop new infiltrates even without COVID-19 symptoms are strongly encouraged.