COVID-19 Pneumonia Treated with Ultra-Low Doses of Radiotherapy in ULTRA-COVID Study

Radiotherapy could play a role in reducing the inflammatory response in lungs and relieve life-threatening symptoms of COVID-19 patients, according to a new study.

Researcher at La Milagrosa Hospital (Madrid, Spain) designed a prospective study of Ultra-Low Doses of Therapy with Radiation Applied to COVID-19 (ULTRA-COVID) for patients who suffer pneumonia, are not candidates for invasive mechanical ventilation and show no improvement with medical therapy. Based on preliminary results of two patients diagnosed with COVID-19 pneumonia treated with ULTRA-COVID, significant clinical response and a good radiological response was observed in both cases after one radiotherapy session, resulting in both patients being discharged from hospital in less than two weeks after radiation treatment.

Although the majority of COVID-19 patients are asymptomatic, complications such as severe pneumonia, respiratory failure, or acute respiratory distress syndrome (ARDS) can occur, often leading to fatal outcomes for patients. Most of the time, these cases require intensive care unit (ICU) admission and invasive mechanical ventilator (IMV) support. In the case of these critically ill patients, the host response against the virus appears to be mediated by a ‘cytokine storm or release syndrome (CRS)’, leading to a macrophage-mediated inflammatory mechanism (inflammatory M1-phenotype) and ARDS, in the form of bilateral pneumonitis. In order to prevent patient progression to the critical state, the researchers conducted a study to establish the efficacy of LDRT, as an anti-inflammatory treatment in patients with COVID-19 pneumonia and with a poor response to medical treatment who would otherwise be eligible for IMV, but because of other comorbidities they were not ICU candidates.

Out of the two patients diagnosed with COVID-19 pneumonia who were treated with ULTRA-COVID, the first showed an improvement on his Sp02 and Pa02/Fi02 (> 300) two days after the treatment. Supplemental oxygen with 2 L NC was discontinued at day five, he was discharged on day eight after ULTRA-COVID with 95% Sp02 values on air, and his condition remained stable one and two months later. The second patient showed a slower recovery, achieving less need of oxygen support at 2, 5 and 7 days after the treatment, intermittently requiring 2 L NC 1 month after and, dropping oxygen support two months after treatment. Pa02/Fi02 was > 300 mm Hg at day 5 and she was discharged 14 days after ultra-LDRT. ULTRA-COVID intervention showed an improvement of the TSS score in both patients after the first scan.

Based on the preliminary clinical and radiological results, the researchers concluded that there was potential benefit of treating SARS-CoV‑2 pneumonia with ultra-LDRT during the acute inflammatory phase with a positive impact on the disease’s evolution and patient recovery.

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La Milagrosa Hospital