ESTRO 2022

Session Item

Mixed sites/palliation

Session Type: Poster (digital)

Track: Clinical

Journey:

Clinical Outcome and Radiologic Changes in SARS-CoV-2 Pneumonia treated with Low-Dose Radiotherapy.

Johana Cristina Acosta Arteaga, Spain

Presentation Number: PO-1450

Abstract

Abstract Title:

Clinical Outcome and Radiologic Changes in SARS-CoV-2 Pneumonia treated with Low-Dose Radiotherapy.

Authors:

Johana Cristina Acosta Arteaga¹, Laura Torres Royo², Elizabet Rodríguez-Tomàs³, Gabriel De Febrer⁴, Carlos Vasco⁵, Junior Anderson Gomez⁶, Pablo Araguas⁶, Barbara Malave⁶, Miguel Arquez⁷, Manuel Algara⁸, Angel Montero⁹, Manuel Montero¹⁰, Josep M. Simo¹¹, Xavier Gavaldà¹², Berta Pique¹³, David Parada¹⁴, Sebastia Sabater¹⁵, Jordi Camps¹⁶, Jorge Joven¹⁷, Meritxell Arenas¹⁸

¹Universitary Hospital Sant Joan Reus, Radiation Oncology, Tarragona, Spain; ² Universitary Hospital Sant Joan reus, Radiation Oncology., Tarragona, Spain; ³Universitat Rovira i Virgili, Unitat de Recerca Biomèdica. , Tarragona, Spain; ⁴Hospital Universitari Sant Joan de Reus, Geriatric and Palliative care, Tarragona, Spain; ⁵Hospital Universitari Sant Joan de Reus , Department of Geriatric and Palliative care , Tarragona, Spain; ⁶Hospital Universitari Sant Joan de Reus, Radiation Oncology, Tarragona, Spain; ⁷ Hospital Universitari Sant Joan de Reus, Radiation Oncology, Tarragona, Spain; ⁸Hospital del Mar , Department of Radiation Oncology, Barcelona, Spain; ⁹ HM Hospitales, Radiation Oncology, Madrid, Spain; ¹⁰Hospital Universitari Sant Joan de Reus, Department of Radiology, Tarragona, Spain; ¹¹Hospital Universitari de Sant Joan de Reus, Laboratori de Referència Sud., Tarragona, Spain; ¹²Hospital Universitari de Sant Joan, Laboratori de Referència Sud. , Tarragona, Spain; ¹³Hospital Universitari Sant Joan de Reus , Department of Pathology, Tarragona, Spain; ¹⁴ Hospital Universitari Sant Joan de Reus, Department of Pathology, Tarragona, Spain; ¹⁵ Complejo Hospitalario de Albacete, Radiation Oncology, Albacete, Spain; ¹⁶Institut d’Investigacions Pere Virgili, Unitat de Recerca Biomèdica. Universitat Rovira i Virgili, Tarragona, Spain; ¹⁷Institut d’Investigacions Pere Virgili, Unitat de Recerca Biomèdica. Universitat Rovira i Virgili, Tarragona, Spain; ¹⁸ Hospital Universitari Sant Joan de Reus, Radiation Oncology, Tarragona, Spain

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Purpose or Objective

To assess the clinical, chemical and radiological response in patients receiving LD-Radiotherapy for SARS-CoV-2 pneumonia.

Material and Methods

This observational study was conducted between June 2020 and February 2021. Fifty inpatients of our centre were included after accepting the appropriate informed consent form_{(Tab 1)}.They had moderate to severe SARS-CoV-2 pneumonia, no clinical response to pharmacological approach and were no candidates for invasive mechanical ventilation.These patients were treated during the acute phase of the viral infection with a single dose of 0.5 Gy to the whole thorax. Clinical follow-up, as well as chemical(CPR, IL-6, Ferritin) and radiological parameters were analysed at 7 days and 1 month after treatment. SAFI was classified in mild, moderate and severe. Radiologically, CT scans were classified according to the degree of parenchymal involvement

Tab 1 Fig1

Results

50 patients, with a mean age of 84 years-old ,were enrolled. Results were obtained from 34(68%) patients one week after irradiation (11 patients died before the week and 5 of them were in poor condition for further examinations). And 32 (64%) patients reached the month after LD-RT. Three of them decided not to continue with the study, and one only accepted the CT control, so the biochemistry data collected comes from 28 (56%) instead. In all, 18 patients died, 15 due to COVID-19 pneumonia and 3 due to other causes.

Registered basal SAFI was severe on 22% patients, moderate on 20% and mild on 58%. At 24 hours was severe on 21.7%, moderate on 10.9% and mild on 67.4% of patients. One week after, SAFI results were severe on 6.1%,moderate on 3% and mild on 90% patients. In a month, every patient showed mild SAFI, none of them requiring supplemental oxygen therapy.Analytically, a progressive decrease of inflammatory parameters was observed in a month. CRP was observed with a baseline mean of 7.86 mg/dl to 2.88mg/dl, IL6 went from 67.9 pg/ml to 15.81 pg/ml, Ferritin from 1543 ng/ml to 390 ng/ml at one month of treatment.

Radiologically, 34% of the sample had >75% parenchymal involvement in the CT before RT, 46% had 50-75% involvement, 16%, had 25-50% involvement and 2%, had 5-25%. One week after treatment, 35 patients undertook a comparative CT scan, 66% of patients showed radiological improvement (no patient had >75% involvement, 10% presented involvement of 50-75 %, 26 % of 25-50%, 26% of 5-25% and 8% of the sample <5%), only one had a worse radiological situation, and another one the affected parenchymal percentage had not changed.One month after LD-RT, 29 patients had their comparative CT and 2% of patients presented 25-50% parenchyma involvement, 10% showed 5-25% involvement and 46% presented <5%_(Fig.1).

Conclusion

Positive clinical response associated with noticeable chemical and radiological results was observed after whole thorax LD-RT in patients with bilateral SARS CoV-2 pneumonia. The observed results encourage the comparison with a control group to determine the clinical benefit of LD-RT