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Arenas M, Piqué B, Torres-Royo L, Acosta JC, Rodríguez-Tomàs E, De Febrer G, Vasco C, Araguas P, Gómez JA, Malave B, Árquez M, Algara M, Montero A, Montero M, Simó JM, Gabaldó X, Parada D, Riu F, Sabater S, Camps J, Joven J. Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients : The SEOR-GICOR IPACOVID comparative cohort trial. Strahlenther Onkol 2023; 199:847-856. [PMID: 37000224 PMCID: PMC10064634 DOI: 10.1007/s00066-023-02067-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/19/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE To assess the efficacy of lung low-dose radiotherapy (LD-RT) in the treatment of patients with COVID-19 pneumonia. MATERIALS AND METHODS Ambispective study with two cohorts to compare treatment with standard of care (SoC) plus a single dose of 0.5 Gy to the whole thorax (experimental prospective cohort) with SoC alone (control retrospective cohort) for patients with COVID-19 pneumonia not candidates for admission to the intensive care unit (ICU) for mechanical ventilation. RESULTS Fifty patients treated with LD-RT were compared with 50 matched controls. Mean age was 85 years in both groups. An increase in arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (PAFI) in the experimental LD-RT-treated group compared to the control group could not be found at 48 h after LD-RT, which was the primary endpoint of the study. However, PAFI values significantly improved after 1 month (473 vs. 302 mm Hg; p < 0.0001). Pulse oxymetric saturation/fraction of inspired oxygen (SAFI) values were also significantly higher in LD-RT-treated patients than in control patients at 1 week (405 vs. 334 mm Hg; p = 0.0157) and 1 month after LD-RT (462 vs. 326 mm Hg; p < 0.0001). All other timepoint measurements of the respiratory parameters were similar across groups. Patients in the experimental group were discharged from the hospital significantly earlier (23 vs. 31 days; p = 0.047). Fifteen and 26 patients died due to COVID-19 pneumonia in the experimental and control cohorts, respectively (30% vs. 48%; p = 0.1). LD-RT was associated with a decreased odds ratio (OR) for 1‑month COVID-19 mortality (OR = 0.302 [0.106-0.859]; p = 0.025) when adjusted for potentially confounding factors. Overall survival was significantly prolonged in the LD-RT group compared to the control group (log-rank p = 0.027). No adverse events related to radiation treatment were observed. CONCLUSION Treatment of frail patients with COVID-19 pneumonia with SoC plus single-dose LD-RT of 0.5 Gy improved respiratory parameters, reduced the period of hospitalization, decreased the rate of 1‑month mortality, and prolonged actuarial overall survival compared to SoC alone.
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Affiliation(s)
- M. Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - B. Piqué
- Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - L. Torres-Royo
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - J. C. Acosta
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - E. Rodríguez-Tomàs
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - G. De Febrer
- Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - C. Vasco
- Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - P. Araguas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - J. A. Gómez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - B. Malave
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - M. Árquez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - M. Algara
- Department of Radiation Oncology, Hospital del Mar, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Mèdiques, Barcelona, Spain
| | - A. Montero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - M. Montero
- Department of Radiology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - J. M. Simó
- Laboratori de Referència Sud, Hospital Universitari de Sant Joan, Tarragona, Spain
| | - X. Gabaldó
- Laboratori de Referència Sud, Hospital Universitari de Sant Joan, Tarragona, Spain
| | - D. Parada
- Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - F. Riu
- Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - S. Sabater
- Department of Radiation Oncology, Complejo Hospitalario de Albacete, Albacete, Spain
| | - J. Camps
- Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
| | - J. Joven
- Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
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Acosta Arteaga J, Torres Royo L, Rodríguez-Tomàs E, De Febrer G, Vasco C, Gomez J, Araguas P, Malave B, Arquez M, Algara M, Montero A, Montero M, Simo J, Gavaldà X, Pique B, Parada D, Sabater S, Camps J, Joven J, Arenas M. PO-1450 Clinical Outcome and Radiologic Changes in SARS-CoV-2 Pneumonia treated with Low-Dose Radiotherapy. Radiother Oncol 2022. [PMCID: PMC9153878 DOI: 10.1016/s0167-8140(22)03414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Arenas M, Algara M, De Febrer G, Rubio C, Sanz X, de la Casa MA, Vasco C, Marín J, Fernández-Letón P, Villar J, Torres-Royo L, Villares P, Membrive I, Acosta J, López-Cano M, Araguas P, Quera J, Rodríguez-Tomás F, Montero A. Could pulmonary low-dose radiation therapy be an alternative treatment for patients with COVID-19 pneumonia? Preliminary results of a multicenter SEOR-GICOR nonrandomized prospective trial (IPACOVID trial). Strahlenther Onkol 2021; 197:1010-1020. [PMID: 34230996 PMCID: PMC8260020 DOI: 10.1007/s00066-021-01803-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 02/08/2023]
Abstract
Purpose To evaluate the efficacy and safety of lung low-dose radiation therapy (LD-RT) for pneumonia in patients with coronavirus disease 2019 (COVID-19). Materials and methods Inclusion criteria comprised patients with COVID-19-related moderate–severe pneumonia warranting hospitalization with supplemental O2 and not candidates for admission to the intensive care unit because of comorbidities or general status. All patients received single lung dose of 0.5 Gy. Respiratory and systemic inflammatory parameters were evaluated before irradiation, at 24 h and 1 week after LD-RT. Primary endpoint was increased in the ratio of arterial oxygen partial pressure (PaO2) or the pulse oximetry saturation (SpO2) to fractional inspired oxygen (FiO2) ratio of at least 20% at 24 h with respect to the preirradiation value. Results Between June and November 2020, 36 patients with COVID-19 pneumonia and a mean age of 84 years were enrolled. Seventeen were women and 19 were men and all of them had comorbidities. All patients had bilateral pulmonary infiltrates on chest X‑ray. All patients received dexamethasone treatment. Mean SpO2 pretreatment value was 94.28% and the SpO2/FiO2 ratio varied from 255 mm Hg to 283 mm Hg at 24 h and to 381 mm Hg at 1 week, respectively. In those who survived (23/36, 64%), a significant improvement was observed in the percentage of lung involvement in the CT scan at 1 week after LD-RT. No adverse effects related to radiation treatment have been reported. Conclusions LD-RT appears to be a feasible and safe option in a population with COVID-19 bilateral interstitial pneumonia in the presence of significant comorbidities. Supplementary Information The online version of this article (10.1007/s00066-021-01803-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M. Arenas
- Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - M. Algara
- Department of Radiation Oncology, Hospital del Mar, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - G. De Febrer
- Universitat Rovira i Virgili, Tarragona, Spain
- Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - C. Rubio
- Department of Radiation Oncology, HM Hospitales., Madrid, Spain
| | - X. Sanz
- Department of Radiation Oncology, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
- Pompeu Fabra University Barcelona, Barcelona, Spain
| | | | - C. Vasco
- Universitat Rovira i Virgili, Tarragona, Spain
- Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - J. Marín
- Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
- Department of Critical Care, Hospital del Mar, Barcelona, Spain
| | | | - J. Villar
- Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
- Department of Infection Diseases, Hospital del Mar, Barcelona, Spain
| | - L. Torres-Royo
- Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - P. Villares
- Department of Internal Medicine, HM Hospitales, Madrid, Spain
| | - I. Membrive
- Department of Radiation Oncology, Hospital del Mar, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - J. Acosta
- Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - M. López-Cano
- Department of Internal Medicine, HM Hospitales, Madrid, Spain
| | - P. Araguas
- Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - J. Quera
- Department of Radiation Oncology, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
- Pompeu Fabra University Barcelona, Barcelona, Spain
| | - F. Rodríguez-Tomás
- Universitat Rovira i Virgili, Tarragona, Spain
- Institut d’Investigacions Pere Virgili, Tarragona, Spain
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - A. Montero
- Department of Radiation Oncology, HM Hospitales., Madrid, Spain
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