Low-dose radiotherapy for COVID-19 pneumonia treatment: case report, procedure, and literature review
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CASE STUDY
Low-dose radiotherapy for COVID-19 pneumonia treatment: case report, procedure, and literature review Ruben Del Castillo1 · David Martinez1 · Gustavo J. Sarria1 · Luis Pinillos1 · Bertha Garcia1 · Luis Castillo2 · Alicia Carhuactocto1 · Frank A. Giordano3 · Gustavo R. Sarria3 Received: 14 June 2020 / Accepted: 27 July 2020 © The Author(s) 2020
Abstract Background The COVID-19 pandemic outbreak has set the emergency services in developing countries on major alert, as the installed response capacities are easily overwhelmed by the constantly increasing high demand. The deficit of intensive care unit beds and ventilators in countries like Peru is forcing practitioners to seek preventive or early interventional strategies to prevent saturating these chronically neglected facilities. Case presentation A 64-year-old patient is reported after presenting with COVID-19 pneumonia and rapidly progressing to deteriorated ventilatory function. Compassionate treatment with a single 1-Gy dose to the bilateral whole-lung volume was administered, with gradual daily improvement of ventilatory function and decrease in serum inflammatory markers and oxygen support needs, including intubation. No treatment-related toxicity developed. Procedures of transport, disinfection, and treatment planning and delivery are described. Conclusion Whole-lung low-dose radiotherapy seems to be a promising approach for avoiding or delaying invasive respiratory support. Delivered low doses are far from meeting toxicity ranges. On-going prospective trials will elucidate the effectiveness of this approach.
Keywords COVID-19 · Low-dose radiotherapy · Viral pneumonia · Intensive care · Cytokine storm
Introduction The coronavirus disease 2019 (COVID-19) pandemic outbreak in late 2019 eventually imposed upon developing countries a major problem for public health systems, due to a lack of installed attention capacity [1]. Examples from European countries such as Spain or Italy, who saw their emergency and hospitalization systems rapidly overwhelmed despite a greater response capacity [2], raised major concern in Latin American countries. In Peru, a major population mobility restriction was introduced on March 15 [3], in
Gustavo R. Sarria, MD
[email protected] 1
Department of Radiation Oncology, Clinica Delgado-AUNA, Lima, Peru
2
Department of Critical Care, Clinica Delgado-AUNA, Lima, Peru
3
Department of Radiation Oncology, University Hospital Bonn, Universitätsklinikum Bonn, Venusberg Campus 1, Building 55, 53127 Bonn, Germany
order to alleviate the admission rates in a country where, according to official numbers, the overall availability of mechanical ventilators (MV) does not exceed 822 for a total of ~33 million inhabitants [3]. Despite these efforts and as of May 25, the contagion incidence curves seem to still be increasing, with an average of more than 4000 new cases daily since the first official case was reported on March 6 [3, 4]. Currently, in light of the lack of evidence for a specific or effective medical treatmen
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