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.

Autor: Arenas M; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain. meritxell.arenas@urv.cat.; Institut d'Investigacions Pere Virgili, Tarragona, Spain. meritxell.arenas@urv.cat., Piqué B; Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain., Torres-Royo L; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain., Acosta JC; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain., Rodríguez-Tomàs E; 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., De Febrer G; Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain., Vasco C; Department of Geriatric and Palliative care, Hospital Universitari Sant Joan de Reus, Tarragona, Spain., Araguas P; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain., Gómez JA; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain., Malave B; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain., Árquez M; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain., Algara M; Department of Radiation Oncology, Hospital del Mar, Barcelona, Spain.; Autonomous University of Barcelona, Barcelona, Spain.; Institut d'Investigacions Mèdiques, Barcelona, Spain., Montero A; Department of Radiation Oncology, HM Hospitales, Madrid, Spain., Montero M; Department of Radiology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain., Simó JM; Laboratori de Referència Sud, Hospital Universitari de Sant Joan, Tarragona, Spain., Gabaldó X; Laboratori de Referència Sud, Hospital Universitari de Sant Joan, Tarragona, Spain., Parada D; Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain., Riu F; Department of Pathology, Hospital Universitari Sant Joan de Reus, Tarragona, Spain., Sabater S; Department of Radiation Oncology, Complejo Hospitalario de Albacete, Albacete, Spain., Camps J; Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain., Joven J; Unitat de Recerca Biomèdica, Universitat Rovira i Virgili, Tarragona, Spain.; Institut d'Investigacions Pere Virgili, Tarragona, Spain.
Jazyk: angličtina
Zdroj: Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] [Strahlenther Onkol] 2023 Sep; Vol. 199 (9), pp. 847-856. Date of Electronic Publication: 2023 Mar 31.
DOI: 10.1007/s00066-023-02067-9
Abstrakt: 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 (PaO 2 )/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.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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