Low-dose Whole-lung Irradiation for COVID-19 Pneumonia: Short Course Results

Low-dose Whole-lung Irradiation for COVID-19 Pneumonia: Short Course Results | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Low-dose Whole-lung Irradiation for COVID-19 Pneumonia: Short Course Results Ahmad Ameri, Nazanin Rahnama, Rama Bozorgmehr, Majid Mokhtari, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-40507/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Dec, 2020 Read the published version in International Journal of Radiation Oncology*Biology*Physics → Version 1 posted You are reading this latest preprint version Abstract Objectives: The COVID-19 outbreak is affecting people worldwide. Most of the infected patients suffering from respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiotherapy in patients with COVID-19 pneumonia. Methods: In this clinical trial, done in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (IL-6 and CRP) were recorded before and after irradiation. Results: Between 21 May 2020 and 24 June 2020, five patients received whole-lung irradiation. They followed for 5-7 days to evaluate response to treatment and toxicities. The clinical and paraclinical findings of four patients (except for patient #4 that get worst and died on day 3) improved on the first day of irradiation. Patient #3 opted-out the trial on the third day of irradiation. The mean time to discharge was 6 days for the other three patients. No acute radiation-induced toxicity was recorded. Conclusion: With a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia. Infectious Diseases Pulmonology Hospital Medicine COVID-19 Pneumonia Low dose radiotherapy Lung Figures Figure 1 Background Since the end of 2019, the novel coronavirus disease (COVID-19) has been a major health issue all over the world. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has led to more than five hundred thousand deaths until July 2020 with an estimated crude mortality rate of 3-4% [1-3]. Four phases are proposed for the pathogenesis of SARS-CoV-2, including suppression of interferon type 1 (IFN-1) production, blockage of IFN-1 signaling, massive inflammatory response (so-called cytokine storm), and immune exhaustion [4]. The lethality of COVID-19 mainly pertains to the cytokine storm-induced thrombotic dysregulation and multi-organ failure [5]. During the cytokine storm, monocytes and macrophages mainly recruit, which may explain elevated levels of pro-inflammatory cytokines such as interleukin-6 (IL-6) [5]. Suppression of cytokine storm can potentially reduce the morbidity and mortality of COVID-19 [6]. Experimental studies have demonstrated the anti-inflammatory effect of low dose radiotherapy (LD-RT) by modulating the function of a variety of inflammatory cells, including endothelial cells, polymorphonuclear leukocytes, and macrophages [7-12]. Being such, LD-RT is considered as an opportunity to block the deadly cytokine storm and save the patients’ lives. Herein we report the outcomes of the first 5 patients with COVID-19 pneumonia who were treated with low-dose whole-lung irradiation at Imam Hossein Educational Hospital, Tehran, Iran. Patients And Methods Ethical consideration Before commencing the study, ethical clearance was obtained from the Ethical Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran (Ethical code: IR.SBMU.RETECH.REC.1399.073). Prior to assigning the patients to radiotherapy, written informed consent was obtained. Trial design and participants This pilot clinical trial was conducted at Imam Hossein Educational Hospital to examine the safety and efficacy of single-fraction low-dose whole-lung irradiation in patients with COVID-19 pneumonia (Clinical Trial Registration Number NCT04390412). Individuals more than 60 years old who had clinical manifestations of COVID-19 with a positive polymerase chain reaction (PCR) of the nasopharyngeal swab, antibody test, or radiographic pneumonic consolidations that required oxygen supplementation (with SpO 2 ≤ 93% and/or PaO 2 /FiO 2 ≤ 300 mmHg) were enrolled. For patients who had stable vital signs, we used SpO 2 to estimate PaO 2 [13]. The exclusion criteria were patients with hemodynamic instability or requiring mechanical ventilation, with a history of malignancy or heart failure, with contraindication for radiotherapy, with septic shock or end-organ failure, and with severe acute respiratory distress syndrome (with PaO 2 /FiO 2 ≤ 100 mmHg). The primary objectives were alteration in blood oxygenation (in terms of O2 saturation) and the number of hospital/ICU stay days. The secondary objectives were changes in laboratory results [including C-reactive peptide (CRP) and IL-6]. Clinical recovery was defined as the first day a subject was discharged or weaned from supplemental oxygen. A total of five of 40 eligible patients who approached were signed the consent and entered the study between May 2020 and June 2020. This clinical trial was approved by the Institutional Review Board. Radiotherapy and follow-up The treatment protocol was low-dose whole-lung irradiation in conjunction with the standard national guideline for the management of COVID-19 [14]. All participants allocated to receive single-fraction 0.5 Gy to the whole lungs. Radiation therapy planning was done on patients’ diagnostic CT scans with patients in a supine position using a multislice spiral CT scanner without intravenous contrast. Planning target volume (PTV) covered both lungs in all patients with sufficient margins to account for the intrafraction movements (5–10 mm in our unit). All patients were planned with AP/PA photon fields with a three-dimensional conformal technique using the ISOgray treatment planning system. Vital signs, consciousness, performance status, blood oxygenation, CRP, and IL-6 were assessed at baseline and then daily following the irradiation. To assess core body temperature, we used tympanic membrane thermometry. Results From 21 May 2020 to 24 June 2020, forty patients with COVID-19 pneumonia were asked to participate in the trial and five of them (four males and one female) signed the consent form and received low-dose whole-lung irradiation at the Clinical Oncology department of Imam Hossein Hospital. All participants but one (patient #3) were positive for PCR of the nasopharyngeal swab. Patient #3 was admitted for her loss of consciousness, typical findings of COVID-19 pneumonia in chest CT scan, and elevated CRP level. The baseline characteristics of participants are summarized in Table 1 . The patients were between 60 and 84 years old (mean: 71.8 years). All patients had comorbidities, including hypertension in three patients, past ischemic heart disease in two patients, and heart failure in one patient. At the time of admission, the median Karnofsky Performance Score (KPS) and Glasgow Coma Scale (GCS) were 60 (range 50-80) and 15 (range 10-15), respectively. LD-RT was delivered one to three days after admission day (median 2 days). Table 1 ǀ Patients’ demographics and clinical characteristics Characteristics Patient #1 Patient #2 Patient #3 Patient #4 Patient #5 Gender Male Male Female Male Male Age 60 69 82 84 64 Comorbidity Heart failure HTN, IHD IHD HTN HTN KPS at admission 80 80 60 50 60 GCS at admission 15 15 10 15 15 Presenting symptom(s) Shortness of breath Fever & cough depressed level of consciousness Fever & cough Shortness of breath & Cough Vital signs at admission Pulse rate (per minute) Respiratory rate (per minute) Systolic blood pressure (mmHg) Temperature ( ° C) O 2 saturation (%) P/F ratio 75 12 110 37.5 87 192 88 16 130 38.1 86 126.7 90 20 110 37.6 75 160 82 12 140 37 89 101.4 90 15 120 39 74 110 Between onset of symptoms and RT 1 day 3 days 3 days 2 days 2 days Diagnosis of COVID-19 Clinical findings & PCR Clinical findings & PCR Clinical & imaging findings Clinical findings & PCR Clinical & imaging finding & PCR O 2 supplementation Facial mask Nasal cannula Facial mask with reservoir bag Facial mask Facial mask with reservoir bag Length of stay at hospital after RT 7 days 5 days 3 days 3 days 6 days Outcome Discharged Discharged opted out of trial Expired Discharged GCS, Glasgow coma scale; HTN, hypertension; IHD, ischemic heart disease; KPS, Karnofsky performance scale; PCR, Polymerase chain reaction; P/F ratio, PaO 2 /FiO 2 ; RT; radiation therapy. Four patients (80%) clinically recovered for their O 2 saturation and body temperature within one day. Of these, one patient (patient #3) chose to opt-out of the trial on the third day of irradiation. The mean time to discharge was 6 days for three patients (patient #1, #2, and #5). Patient #4 started to deteriorate with his O 2 saturation and body temperature from the first day of irradiation and died on the third day of irradiation. The laboratory findings (IL-6 and CRP) were in line with the clinical findings. Regarding IL-6, although the fluctuation pattern was documented in patient #1, the overall trendline was as per clinical findings. Figure 1 demonstrates the change in clinical and laboratory findings following irradiation. During the observation, no acute skin, cardiac, pulmonary, or gastric toxicities were detected. Discussion This pilot trial had several important findings. First, for oxygen-dependent patients with COVID-19 pneumonia, whole-lung irradiation had a response rate of 80% in terms of clinical and paraclinical findings. Second, considering the patient opted-out the trial, the clinical recovery of patients receiving LD-RT was 75%. Third, our results showed that LD-RT starts to demonstrate its efficacy from the first day of irradiation. Fourth, CRP changes were consistent with the clinical findings, however, IL-6 showed a fluctuation pattern in one patient but followed the patient’s clinical condition. This may be due to the short-term release of IL-6 upon irradiation [15]. Fifth, despite the clinical efficacy no acute toxicity was reported with LD-RT. To the best of our knowledge, there are three other ongoing clinical trials applying LD-RT in patients with COVID-19 pneumonia. The summary of these trials is presented in Table 2 . Table 2 ǀ Overview of clinical trials evaluating the efficacy of low-dose whole-lung irradiation in patients with COVID-19 pneumonia Clinical trial RESCUE 1-19 COLOR-19 Present trial VENTED NCT number NCT04366791 NCT04377477 NCT04390412 NCT04427566 Start date April 29, 2020 May 6, 2020 May 15, 2020 June 11, 2020 Country of origin United States Italy Iran United States Current status Preliminary results are published in a non-peer reviewed journal Recruiting patients Pilot study (published) Recruiting patients Participants Gender Age (years) Clinical presentation Male/Female ≥ 18 Receiving O 2 with NIV Male/Female ≥ 50 Receiving O 2 with NIV Male/Female > 60 Receiving O 2 with NIV Male/Female ≥ 18 Receiving O 2 with MV Number of participants 5 30 5 (for pilot study) 24 Treatment plan Single-fraction whole-lung irradiation Single-fraction whole-lung irradiation Single-fraction whole-lung irradiation + national guideline Single-fraction whole-lung irradiation Radiation dose (Gy) 1.5 0.7 (on average) 0.5 (+ an additional 0.5 if needed) 0.8 Primary Objectives - Safety - Clinical recovery - Length of hospital stay - No. of ICU admission - Change in blood oxygenation - Length of hospital/ICU stay Mortality rate after 30 days of ICU-based MV initiation ICU, intensive care unit; MV, Mechanical ventilation; NIV, non-invasive ventilation. To the best of our knowledge, the only available results are from RESCUE 1-19 trial that was recently published in a non-peer-reviewed journal [8]. The study detail is summarized in Table 2 . In this pilot study, five patients with COVID-19 pneumonia received whole-lung irradiation with a single-fraction of 1.5 Gy. Four of the patients recovered rapidly and weaned from supplemental oxygen at a mean time of 1.5 days. In all patients, no acute toxicity was reported. Similar findings were reached by our trial in terms of response rate and safety. However, we obtained these results with lower radiation doses. This finding supports the hypothesis that radiation doses as low as 0.5 Gy can modify the immune reaction of COVID-19 pneumonia by activation of macrophages with M2 phenotype [9]. We also included the national protocol for the management of COVID-19 in the treatment plan that may affect the results. We went beyond the RESCUE 1-19 trial by examining the body temperature, IL-6, and CRP of patients following irradiation. Conclusion Notwithstanding the small sample size, the interim results of the RESCUE 1-19 trial and ours demonstrate that LD-RT may be a successful treatment to save patients with severe COVID-19 pneumonia. Longer follow-up with more patients is needed to confirm this notion. Given the encouraging results of this pilot trial, the Ethical Committee of Shahid Beheshti University of Medical Sciences allowed continuing the trial using 1.0 Gy whole-lune irradiation. Declarations Conflicts of interest: The authors have no relevant relationships to disclose. Funding: Not applicable Clinical trial registration number: NCT04390412 Acknowledgments: The authors would like to express their gratitude to staffs of Imam Hossein Hospital, Tehran, Iran. Likewise, authors would like to express their gratitude to all physicians and nurses all around the world who are doing their best efforts to treat patients suffering from COVID-19. References [1] Our World in Data. (2020, June 28, 2020). Mortality risk of COVID-19, . Available: https://ourworldindata.org/coronavirus [2] A. Shankar et al., "Cancer care delivery challenges amidst coronavirus disease–19 (COVID-19) outbreak: specific precautions for cancer patients and cancer care providers to prevent spread," Asian Pacific Journal of Cancer Prevention, vol. 21, no. 3, pp. 569-573, 2020. [3] World Health Organization. (2020, June 28, 2020). Coronavirus disease 2019 (COVID-19) situation report – 46, . Available: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4 [4] F. Taghizadeh-Hesary and H. Akbari, "The powerful immune system against powerful COVID-19: A hypothesis," Medical Hypotheses, p. 109762, 2020. [5] M. Soy, G. Keser, P. Atagündüz, F. Tabak, I. Atagündüz, and S. Kayhan, "Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment," Clinical Rheumatology, p. 1, 2020. [6] P. Horby et al., "Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report," medRxiv, 2020. [7] M. Arenas et al., "Anti-inflammatory effects of low-dose radiotherapy," Strahlentherapie und Onkologie, vol. 188, no. 11, pp. 975-981, 2012. [8] C. B. Hess et al., "Low-Dose Whole-Lung Radiation for COVID-19 Pneumonia: Planned Day-7 Interim Analysis of a Registered Clinical Trial," medRxiv, 2020. [9] P. C. Lara, J. Burgos, and D. Macias, "Low dose lung radiotherapy for COVID-19 pneumonia. The rationale for a cost-effective anti-inflammatory treatment," Clinical and Translational Radiation Oncology, 2020. [10] A. Kefayat and F. Ghahremani, "Low dose radiation therapy for COVID-19 pneumonia: a double-edged sword," Radiotherapy and Oncology, 2020. [11] C. Kirkby and M. Mackenzie, "Is low dose radiation therapy a potential treatment for COVID-19 pneumonia?," Radiotherapy and Oncology, 2020. [12] E. V. POWELL, "Roentgen therapy of lobar pneumonia," Journal of the American Medical Association, vol. 110, no. 1, pp. 19-22, 1938. [13] S. M. Gadrey et al., "Imputation of partial pressures of arterial oxygen using oximetry and its impact on sepsis diagnosis," Physiological Measurement, vol. 40, no. 11, p. 115008, 2019. [14] Ministry of Health. (July 1, 2020). دستورالعمل درمان رادیوتراپی در بیماران مبتلا به سرطان در پاندومی کووید 19. Available: http://treatment.sbmu.ac.ir/uploads/2-2-zip_saratan.zip [15] V. De Sanctis et al., "Cytokines, fatigue, and cutaneous erythema in early stage breast cancer patients receiving adjuvant radiation therapy," BioMed research international, vol. 2014, 2014. Cite Share Download PDF Status: Published Journal Publication published 01 Dec, 2020 Read the published version in International Journal of Radiation Oncology*Biology*Physics → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-40507","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":776194,"identity":"60fea9e6-7c2d-41f9-92e4-67a99eeae346","order_by":0,"name":"Ahmad Ameri","email":"","orcid":"","institution":"Associate Professor of Radiation Oncology, Department of Clinical Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"","lastName":"Ameri","suffix":""},{"id":776195,"identity":"e2146ea0-0d27-44e2-a278-bd1e0d46ae2e","order_by":1,"name":"Nazanin Rahnama","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBACgwNgkkGOX/7wwQcfgGw2diK1GEvOYEs2nAHSwkxAi2QDhE7ccIPHTJoHxCSkhZ/9+MNPNwruJM6c3WAgbfNrmzwfMwPjh485uLWw8eQYS+cYPDPulzmQYJzbd9uwjZmBWXLmNjxaGHIYgFoOy85sSDiQnNtzmxGohY2ZF58W/uePfwO1MG44kNhw2LLntj1hLRIJZiBbFDfcSGZsZvhxO5EILW/MrIFajCV7jjEz9jbcTm5jZmzG7xf+9Me3c/4cluNn7//+48ef27bz25sPfviIRwsqYGwDkw3EqgeBP6QoHgWjYBSMgpECALdlVA+khyHIAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Clinical Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Nazanin","middleName":"","lastName":"Rahnama","suffix":""},{"id":776196,"identity":"c1c78af8-e2e1-4743-b67e-8634e33a7412","order_by":2,"name":"Rama Bozorgmehr","email":"","orcid":"","institution":" Assistant Professor of Pulmonology, Clinical Research Development Unit, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 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It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has led to more than five hundred thousand deaths until July 2020 with an estimated crude mortality rate of 3-4% [1-3]. Four phases are proposed for the pathogenesis of SARS-CoV-2, including suppression of interferon type 1 (IFN-1) production, blockage of IFN-1 signaling, massive inflammatory response (so-called cytokine storm), and immune exhaustion [4]. The lethality of COVID-19 mainly pertains to the cytokine storm-induced thrombotic dysregulation and multi-organ failure [5]. During the cytokine storm, monocytes and macrophages mainly recruit, which may explain elevated levels of pro-inflammatory cytokines such as interleukin-6 (IL-6) [5]. Suppression of cytokine storm can potentially reduce the morbidity and mortality of COVID-19 [6]. Experimental studies have demonstrated the anti-inflammatory effect of low dose radiotherapy (LD-RT) by modulating the function of a variety of inflammatory cells, including endothelial cells, polymorphonuclear leukocytes, and macrophages [7-12]. Being such, LD-RT is considered as an opportunity to block the deadly cytokine storm and save the patients\u0026rsquo; lives. Herein we report the outcomes of the first 5 patients with COVID-19 pneumonia who were treated with low-dose whole-lung irradiation at Imam Hossein Educational Hospital, Tehran, Iran.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Patients And Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore commencing the study, ethical clearance was obtained from the Ethical Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran (Ethical code: IR.SBMU.RETECH.REC.1399.073). Prior to assigning the patients to radiotherapy, written informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis pilot clinical trial was conducted at Imam Hossein Educational Hospital to examine the safety and efficacy of single-fraction low-dose whole-lung irradiation in patients with COVID-19 pneumonia (Clinical Trial Registration Number NCT04390412). Individuals more than 60 years old who had clinical manifestations of COVID-19 with a positive polymerase chain reaction (PCR) of the nasopharyngeal swab, antibody test, or radiographic pneumonic consolidations that required oxygen supplementation (with SpO\u003csub\u003e2\u003c/sub\u003e \u0026le; 93% and/or PaO\u003csub\u003e2\u003c/sub\u003e/FiO\u003csub\u003e2\u003c/sub\u003e \u0026le; 300 mmHg) were enrolled. For patients who had stable vital signs, we used SpO\u003csub\u003e2\u003c/sub\u003e to estimate PaO\u003csub\u003e2\u003c/sub\u003e [13]. The exclusion criteria were patients with hemodynamic instability or requiring mechanical ventilation, with a history of malignancy or heart failure, with contraindication for radiotherapy, with septic shock or end-organ failure, and with severe acute respiratory distress syndrome (with PaO\u003csub\u003e2\u003c/sub\u003e/FiO\u003csub\u003e2\u003c/sub\u003e \u0026le; 100 mmHg). The primary objectives were alteration in blood oxygenation (in terms of O2 saturation) and the number of hospital/ICU stay days. The secondary objectives were changes in laboratory results [including C-reactive peptide (CRP) and IL-6]. Clinical recovery was defined as the first day a subject was discharged or weaned from supplemental oxygen. A total of five of 40 eligible patients who approached were signed the consent and entered the study between May 2020 and June 2020. This clinical trial was approved by the Institutional Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiotherapy and follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe treatment protocol was low-dose whole-lung irradiation in conjunction with the standard national guideline for the management of COVID-19 [14]. All participants allocated to receive single-fraction 0.5 Gy to the whole lungs. Radiation therapy planning was done on patients\u0026rsquo; diagnostic CT scans with patients in a supine position using a multislice spiral CT scanner without intravenous contrast. Planning target volume (PTV) covered both lungs in all patients with sufficient margins to account for the intrafraction movements (5\u0026ndash;10 mm in our unit). All patients were planned with AP/PA photon fields with a three-dimensional conformal technique using the ISOgray treatment planning system. Vital signs, consciousness, performance status, blood oxygenation, CRP, and IL-6 were assessed at baseline and then daily following the irradiation. To assess core body temperature, we used tympanic membrane thermometry.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFrom 21 May 2020 to 24 June 2020, forty patients with COVID-19 pneumonia were asked to participate in the trial and five of them (four males and one female) signed the consent form and received low-dose whole-lung irradiation at the Clinical Oncology department of Imam Hossein Hospital. All participants but one (patient #3) were positive for PCR of the nasopharyngeal swab. Patient #3 was admitted for her loss of consciousness, typical findings of COVID-19 pneumonia in chest CT scan, and elevated CRP level. The baseline characteristics of participants are summarized in \u003cstrong\u003eTable 1\u003c/strong\u003e. The patients were between 60 and 84 years old (mean: 71.8 years). All patients had comorbidities, including hypertension in three patients, past ischemic heart disease in two patients, and heart failure in one patient. At the time of admission, the median Karnofsky Performance Score (KPS) and Glasgow Coma Scale (GCS) were 60 (range 50-80) and 15 (range 10-15), respectively. LD-RT was delivered one to three days after admission day (median 2 days).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003eǀ\u003c/strong\u003e Patients\u0026rsquo; demographics and clinical characteristics\u003c/p\u003e\n\u003ctable width=\"789\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient #1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient #2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient #3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient #4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient #5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eHeart failure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eHTN, IHD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eIHD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eHTN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eHTN\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eKPS at admission\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eGCS at admission\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003ePresenting symptom(s)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eShortness of breath\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eFever \u0026amp; cough\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003edepressed level of consciousness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eFever \u0026amp; cough\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eShortness of breath \u0026amp; Cough\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eVital signs at admission\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Pulse rate (per minute)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Respiratory rate (per minute)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Systolic blood pressure (mmHg)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Temperature (\u003c/strong\u003e\u003cstrong\u003e\u0026deg;\u003c/strong\u003e\u003cstrong\u003eC)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; O\u003csub\u003e2\u003c/sub\u003e saturation (%)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; P/F ratio\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003cp\u003e37.5\u003c/p\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003cp\u003e192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e88\u003c/p\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003cp\u003e130\u003c/p\u003e\n\u003cp\u003e38.1\u003c/p\u003e\n\u003cp\u003e86\u003c/p\u003e\n\u003cp\u003e126.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003cp\u003e37.6\u003c/p\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003cp\u003e160\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e140\u003c/p\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003cp\u003e89\u003c/p\u003e\n\u003cp\u003e101.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003cp\u003e110\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eBetween onset of symptoms and RT \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e1 day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e3 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e3 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e2 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e2 days\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis of COVID-19\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eClinical findings \u0026amp; PCR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eClinical findings \u0026amp; PCR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eClinical \u0026amp; imaging findings\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eClinical findings \u0026amp; PCR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eClinical \u0026amp; imaging finding \u0026amp; PCR\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"177\"\u003e\n\u003cp\u003e\u003cstrong\u003eO\u003csub\u003e2\u003c/sub\u003e supplementation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003eFacial mask\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eNasal cannula\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"162\"\u003e\n\u003cp\u003eFacial mask with reservoir bag\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eFacial mask\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eFacial mask with reservoir bag\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eLength of stay at hospital after RT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e7 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e5 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e3 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e3 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003e6 days\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eDischarged\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eDischarged\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003eopted out of trial\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003eExpired\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\n\u003cp\u003eDischarged\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"114\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"102\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eGCS, Glasgow coma scale; HTN, hypertension; IHD, ischemic heart disease; KPS, Karnofsky performance scale; PCR, Polymerase chain reaction; P/F ratio, PaO\u003csub\u003e2\u003c/sub\u003e/FiO\u003csub\u003e2\u003c/sub\u003e; RT; radiation therapy.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFour patients (80%) clinically recovered for their O\u003csub\u003e2\u003c/sub\u003e saturation and body temperature within one day. Of these, one patient (patient #3) chose to opt-out of the trial on the third day of irradiation. The mean time to discharge was 6 days for three patients (patient #1, #2, and #5). Patient #4 started to deteriorate with his O\u003csub\u003e2\u003c/sub\u003e saturation and body temperature from the first day of irradiation and died on the third day of irradiation. The laboratory findings (IL-6 and CRP) were in line with the clinical findings. Regarding IL-6, although the fluctuation pattern was documented in patient #1, the overall trendline was as per clinical findings. \u003cstrong\u003eFigure 1\u003c/strong\u003e demonstrates the change in clinical and laboratory findings following irradiation. During the observation, no acute skin, cardiac, pulmonary, or gastric toxicities were detected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThis pilot trial had several important findings. First, for oxygen-dependent patients with COVID-19 pneumonia, whole-lung irradiation had a response rate of 80% in terms of clinical and paraclinical findings. Second, considering the patient opted-out the trial, the clinical recovery of patients receiving LD-RT was 75%. Third, our results showed that LD-RT starts to demonstrate its efficacy from the first day of irradiation. Fourth, CRP changes were consistent with the clinical findings, however, IL-6 showed a fluctuation pattern in one patient but followed the patient\u0026rsquo;s clinical condition. This may be due to the short-term release of IL-6 upon irradiation [15]. Fifth, despite the clinical efficacy no acute toxicity was reported with LD-RT.\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, there are three other ongoing clinical trials applying LD-RT in patients with COVID-19 pneumonia. The summary of these trials is presented in \u003cstrong\u003eTable 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003cstrong\u003eǀ\u003c/strong\u003e Overview of clinical trials evaluating the efficacy of low-dose whole-lung irradiation in patients with COVID-19 pneumonia\u003c/p\u003e\n\u003ctable width=\"768\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u003cstrong\u003eRESCUE 1-19\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u003cstrong\u003eCOLOR-19\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u003cstrong\u003ePresent trial\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003eVENTED \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eNCT number\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003eNCT04366791\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003eNCT04377477\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003eNCT04390412\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eNCT04427566\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eStart date\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003eApril 29, 2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003eMay 6, 2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003eMay 15, 2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eJune 11, 2020\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eCountry of origin\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003eUnited States\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003eItaly\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003eIran\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eUnited States\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003ePreliminary results are published in a non-peer reviewed journal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003eRecruiting patients\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003ePilot study (published)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eRecruiting patients\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Gender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Age (years)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Clinical presentation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMale/Female\u003c/p\u003e\n\u003cp\u003e\u0026ge; 18\u003c/p\u003e\n\u003cp\u003eReceiving O\u003csub\u003e2\u003c/sub\u003e with NIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMale/Female\u003c/p\u003e\n\u003cp\u003e\u0026ge; 50\u003c/p\u003e\n\u003cp\u003eReceiving O\u003csub\u003e2\u003c/sub\u003e with NIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMale/Female\u003c/p\u003e\n\u003cp\u003e\u0026gt; 60\u003c/p\u003e\n\u003cp\u003eReceiving O\u003csub\u003e2\u003c/sub\u003e with NIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMale/Female\u003c/p\u003e\n\u003cp\u003e\u0026ge; 18\u003c/p\u003e\n\u003cp\u003eReceiving O\u003csub\u003e2\u003c/sub\u003e with MV\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of participants\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e5 (for pilot study)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment plan\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003eSingle-fraction whole-lung irradiation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003eSingle-fraction whole-lung irradiation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003eSingle-fraction whole-lung irradiation + national guideline\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eSingle-fraction whole-lung irradiation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003eRadiation dose (Gy)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e1.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e0.7 (on average)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e0.5 (+ an additional 0.5 if needed)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e- Safety\u003c/p\u003e\n\u003cp\u003e- Clinical recovery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e- Length of hospital stay\u003c/p\u003e\n\u003cp\u003e- No. of ICU admission\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e- Change in blood oxygenation\u003c/p\u003e\n\u003cp\u003e- Length of hospital/ICU stay\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eMortality rate after 30 days of ICU-based MV initiation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"164\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"154\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eICU, intensive care unit; MV, Mechanical ventilation; NIV, non-invasive ventilation.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, the only available results are from RESCUE 1-19 trial that was recently published in a non-peer-reviewed journal [8]. The study detail is summarized in \u003cstrong\u003eTable 2\u003c/strong\u003e. In this pilot study, five patients with COVID-19 pneumonia received whole-lung irradiation with a single-fraction of 1.5 Gy. Four of the patients recovered rapidly and weaned from supplemental oxygen at a mean time of 1.5 days. In all patients, no acute toxicity was reported.\u003c/p\u003e\n\u003cp\u003eSimilar findings were reached by our trial in terms of response rate and safety. However, we obtained these results with lower radiation doses. This finding supports the hypothesis that radiation doses as low as 0.5 Gy can modify the immune reaction of COVID-19 pneumonia by activation of macrophages with M2 phenotype [9]. We also included the national protocol for the management of COVID-19 in the treatment plan that may affect the results. We went beyond the RESCUE 1-19 trial by examining the body temperature, IL-6, and CRP of patients following irradiation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNotwithstanding the small sample size, the interim results of the RESCUE 1-19 trial and ours demonstrate that LD-RT may be a successful treatment to save patients with severe COVID-19 pneumonia. Longer follow-up with more patients is needed to confirm this notion. Given the encouraging results of this pilot trial, the Ethical Committee of Shahid Beheshti University of Medical Sciences allowed continuing the trial using 1.0 Gy whole-lune irradiation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp class=\"Body\" style=\"margin-bottom: .0001pt; text-align: justify; text-justify: kashida; text-kashida: 0%;\"\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e The authors have no relevant relationships to disclose.\u003c/p\u003e\n\u003cp class=\"Body\" style=\"margin-bottom: .0001pt; text-align: justify; text-justify: kashida; text-kashida: 0%;\"\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp class=\"Body\" style=\"margin-bottom: .0001pt; text-align: justify; text-justify: kashida; text-kashida: 0%;\"\u003e\u003cstrong\u003eClinical trial registration number:\u003c/strong\u003e NCT04390412\u003c/p\u003e\n\u003cp class=\"Body\" style=\"margin-bottom: .0001pt; text-align: justify; text-justify: kashida; text-kashida: 0%;\"\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to express their gratitude to staffs of Imam Hossein Hospital, Tehran, Iran. Likewise, authors would like to express their gratitude to all physicians and nurses all around the world who are doing their best efforts to treat patients suffering from COVID-19.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e[1]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Our World in Data. (2020, June 28, 2020). Mortality risk of COVID-19, . Available: \u003ca href=\"https://ourworldindata.org/coronavirus\"\u003ehttps://ourworldindata.org/coronavirus\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e[2]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; A. Shankar et al., \"Cancer care delivery challenges amidst coronavirus disease\u0026ndash;19 (COVID-19) outbreak: specific precautions for cancer patients and cancer care providers to prevent spread,\" Asian Pacific Journal of Cancer Prevention, vol. 21, no. 3, pp. 569-573, 2020.\u003c/p\u003e\n\u003cp\u003e[3]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; World Health Organization. (2020, June 28, 2020). Coronavirus disease 2019 (COVID-19) situation report \u0026ndash; 46, . Available: \u003ca href=\"https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4\"\u003ehttps://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e[4]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; F. Taghizadeh-Hesary and H. Akbari, \"The powerful immune system against powerful COVID-19: A hypothesis,\" Medical Hypotheses, p. 109762, 2020.\u003c/p\u003e\n\u003cp\u003e[5]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; M. Soy, G. Keser, P. Atag\u0026uuml;nd\u0026uuml;z, F. Tabak, I. Atag\u0026uuml;nd\u0026uuml;z, and S. Kayhan, \"Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment,\" Clinical Rheumatology, p. 1, 2020.\u003c/p\u003e\n\u003cp\u003e[6]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; P. Horby et al., \"Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report,\" medRxiv, 2020.\u003c/p\u003e\n\u003cp\u003e[7]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; M. Arenas et al., \"Anti-inflammatory effects of low-dose radiotherapy,\" Strahlentherapie und Onkologie, vol. 188, no. 11, pp. 975-981, 2012.\u003c/p\u003e\n\u003cp\u003e[8]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; C. B. Hess et al., \"Low-Dose Whole-Lung Radiation for COVID-19 Pneumonia: Planned Day-7 Interim Analysis of a Registered Clinical Trial,\" medRxiv, 2020.\u003c/p\u003e\n\u003cp\u003e[9]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; P. C. Lara, J. Burgos, and D. Macias, \"Low dose lung radiotherapy for COVID-19 pneumonia. The rationale for a cost-effective anti-inflammatory treatment,\" Clinical and Translational Radiation Oncology, 2020.\u003c/p\u003e\n\u003cp\u003e[10]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; A. Kefayat and F. Ghahremani, \"Low dose radiation therapy for COVID-19 pneumonia: a double-edged sword,\" Radiotherapy and Oncology, 2020.\u003c/p\u003e\n\u003cp\u003e[11]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; C. Kirkby and M. Mackenzie, \"Is low dose radiation therapy a potential treatment for COVID-19 pneumonia?,\" Radiotherapy and Oncology, 2020.\u003c/p\u003e\n\u003cp\u003e[12]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; E. V. POWELL, \"Roentgen therapy of lobar pneumonia,\" Journal of the American Medical Association, vol. 110, no. 1, pp. 19-22, 1938.\u003c/p\u003e\n\u003cp\u003e[13]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; S. M. Gadrey et al., \"Imputation of partial pressures of arterial oxygen using oximetry and its impact on sepsis diagnosis,\" Physiological Measurement, vol. 40, no. 11, p. 115008, 2019.\u003c/p\u003e\n\u003cp\u003e[14]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Ministry of Health. (July 1, 2020). دستورالعمل درمان رادیوتراپی در بیماران مبتلا به سرطان در پاندومی کووید 19. Available: \u003ca href=\"http://treatment.sbmu.ac.ir/uploads/2-2-zip_saratan.zip\"\u003ehttp://treatment.sbmu.ac.ir/uploads/2-2-zip_saratan.zip\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e[15]\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; V. De Sanctis et al., \"Cytokines, fatigue, and cutaneous erythema in early stage breast cancer patients receiving adjuvant radiation therapy,\" BioMed research international, vol. 2014, 2014.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Pneumonia, Low dose radiotherapy, Lung","lastPublishedDoi":"10.21203/rs.3.rs-40507/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-40507/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e The COVID-19 outbreak is affecting people worldwide. Most of the infected patients suffering from respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiotherapy in patients with COVID-19 pneumonia.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this clinical trial, done in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (IL-6 and CRP) were recorded before and after irradiation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Between 21 May 2020 and 24 June 2020, five patients received whole-lung irradiation. They followed for 5-7 days to evaluate response to treatment and toxicities. The clinical and paraclinical findings of four patients (except for patient #4 that get worst and died on day 3) improved on the first day of irradiation. Patient #3 opted-out the trial on the third day of irradiation. The mean time to discharge was 6 days for the other three patients. No acute radiation-induced toxicity was recorded.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e With a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia.\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","manuscriptTitle":"Low-dose Whole-lung Irradiation for COVID-19 Pneumonia: Short Course Results","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-07-07 22:01:56","doi":"10.21203/rs.3.rs-40507/v1","editorialEvents":[{"type":"communityComments","content":5}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc423327-70ee-48fa-8d54-2460f9027be2","owner":[],"postedDate":"July 7th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":144131,"name":"Infectious Diseases"},{"id":144132,"name":"Pulmonology"},{"id":144133,"name":"Hospital Medicine"}],"tags":[],"updatedAt":"2021-07-22T18:38:51+00:00","versionOfRecord":{"articleIdentity":"rs-40507","link":"https://doi.org/10.1016/j.ijrobp.2020.07.026","journal":{"identity":"international-journal-of-radiation-oncologybiologyphysics","isVorOnly":true,"title":"International Journal of Radiation Oncology*Biology*Physics"},"publishedOn":"2020-12-01 18:38:51","publishedOnDateReadable":"December 1st, 2020"},"versionCreatedAt":"2020-07-07 22:01:56","video":"","vorDoi":"10.1016/j.ijrobp.2020.07.026","vorDoiUrl":"https://doi.org/10.1016/j.ijrobp.2020.07.026","workflowStages":[]},"version":"v1","identity":"rs-40507","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-40507","identity":"rs-40507","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}