Low-dose whole-lung radiation for COVID-19 pneumonia: Planned day 7 interim analysis of a registered clinical trial
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
Background : Individuals of advanced age with comorbidities face a higher risk of death from coronavirus disease 2019 (COVID?19), especially once they are ventilator?dependent. Respiratory decline in patients with COVID?19 is precipitated by a lung?mediated aberrant immune cytokine storm. Low?dose lung radiation was used to treat pneumonia in the pre?antibiotic era. Radiation immunomodulatory effects may improve outcomes for select patients with COVID?19. Methods : A single?institution trial evaluating the safety and efficacy of single?fraction, low?dose whole?lung radiation for patients with COVID?19 pneumonia is being performed for the first time. This report describes outcomes of a planned day 7 interim analysis. Eligible patients were hospitalized, had radiographic consolidation, required supplemental oxygen, and were clinically deteriorating. Results : Of 9 patients screened, 5 were treated with whole?lung radiation on April 24 until April 28 2020, and they were followed for a minimum of 7 days. The median age was 90 years (range, 64?94 years), and 4 were nursing home residents with multiple comorbidities. Within 24 hours of radiation, 3 patients (60%) were weaned from supplemental oxygen to ambient air, 4 (80%) exhibited radiographic improvement, and the median Glasgow Coma Scale score improved from 10 to 14. A fourth patient (80% overall recovery) was weaned from oxygen at hour 96. The mean time to clinical recovery was 35 hours. There were no acute toxicities. Conclusions : In a pilot trial of 5 oxygen?dependent elderly patients with COVID?19 pneumonia, low?dose whole?lung radiation led to rapid improvements in clinical status, encephalopathy, and radiographic consolidation without acute toxicity. Low?dose whole?lung radiation appears to be safe, shows early promise of efficacy, and warrants further study.
Cancer , résumé, 2019