A Low Dose Whole Lung Radiotherapy for Covid-19 Pneumonia: What have we Learned? Opinion of the International Geriatric Radiotherapy Group

Background: Coronavirus disease 19 carry a high mortality rate among older patients and minorities such as ethnic Africans and Latinos through the induction of a cytokines storm. Many pharmacologic interventions were proposed to improve the mortality rate from normal organ damage such as pneumonia. Low dose whole lung radiotherapy has been used in the past to treat pneumonia and may improve survival through modulation of the inflammatory cytokines. However, there is a lot of controversy about the efficacy and safety of this treatment modality. Thus, a review of the clinical studies using irradiation for COVID-19 pneumonia is needed to answer those questions Methods: A literature search of PubMed and Google Scholar was conducted. Reported studies were analyzed to assess safety, efficacy, and inflammatory biomarkers response following low dose whole lung radiotherapy Results: Patients who required artificial ventilation for COVID-19 did not benefit from low dose whole lung radiotherapy, most likely due to severe lung damage. The inflammatory response may be attenuated after irradiation but it is unclear whether it is independent of the steroid effect. Conclusion: Randomized studies are required to assess the effect low dose whole lung radiotherapy for COVID-19 pneumonia and its anti-inflammatory property. Such studies are needed for emerging countries with limited resources as radiotherapy may be cost-effective to reduce hospital admission and intensive care unit monitoring.