Low Dose Radiotherapy in COVID-19 Pneumonia

NCT ID: NCT04390412

Last Updated: 2020-11-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE1/PHASE2

Total Enrollment

5 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-05-04

Study Completion Date

2020-12-31

Brief Summary

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Moderate to severe cases of SARS-associated ARDS based on inclusion/ exclusion criteria and the decision made in multi- disciplinary team are treated with 0.5 Gy whole lung radiation.

Detailed Description

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SARS-associated ARDS (acute respiratory distress syndrome) is the most fatal outcome of COVID-19 systemic infection. To overcome the uncontrolled inflammation leading to ARDS and respiratory failure, several drugs have been investigated in this situation with the most promising results coming from anti-inflammatory agents that directly or indirectly inhibit IL-6 and its counterparts of inflammation.

Low dose radiation, as opposed to high dose, has documented anti-inflammatory effects that are exercised through various mechanisms including decrease in pro-inflammatory cytokines such as IL-6.

In this pilot clinical trial, the patients are carefully selected according to inclusion /exclusion criteria and the clinical judgement of the multi- disciplinary team.Their diagnostic CT scan will be used to plan an AP/ PA radiotherapy treatment to both lungs and the set-up positioning information is obtained from anatomical landmarks. The patient will be referred for a fraction of 0.5 Gy to both lungs and for the next 28 days the clinical para-clinical and radiologic variables of disease severity will be monitored closely. Should the patient's clinical course indicate and the multi- disciplinary team approves, they may be subjected to another fraction of 0.5 Gy to a maximum of 1 Gy in two fractions at least 72 hours apart. All the patients will also receive the standard national protocol of COVID-19 management.

A total of 5 patients will be enrolled in the RT arm, providing favourable results seen in the first set of patients, the team will decide on recruiting a larger number for a phase II clinical trial.

Conditions

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COVID SARS (Severe Acute Respiratory Syndrome)

Keywords

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Low Dose Lung Radiotherapy COVID-19 anti-inflammatory

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Low Dose Radiotherapy

0.5 Gy radiation to both lungs in an AP/PA fashion

Group Type EXPERIMENTAL

Low Dose Radiotherapy

Intervention Type RADIATION

0.5 Gy radiation to both lungs in an AP/PA treatment plan

Interventions

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Low Dose Radiotherapy

0.5 Gy radiation to both lungs in an AP/PA treatment plan

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Confirmed COVID-19 diagnosis ( PCR or serologic or radiographic)
* Presence of pulmonary involvement ( defined by P/F ratio or NIV need)
* Less than 3 days since the onset of ARDS
* Age \> 60 years
* ↑ IL-6 ( if available)
* ↑ CRP

Exclusion Criteria

* Lack of informed consent
* Inability to transfer to the radiation unit
* Hemodynamic instability
* Septic shock and organ dysfunction
* Severe ARDS P/F ratio ≤ 100 mmHg
* History of cardiac failure
* Contraindications to radiation
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Shahid Beheshti University of Medical Sciences

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ahmad Ameri, Prof.

Role: STUDY_CHAIR

Shahid Beheshti University of Medical Sciences

Nazanin Rahnama, M.D.

Role: PRINCIPAL_INVESTIGATOR

Shahid Beheshti University of Medical Sciences

Locations

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Imam Hossein Hospital

Tehran, , Iran

Site Status

Countries

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Iran

References

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Calabrese EJ, Dhawan G. How radiotherapy was historically used to treat pneumonia: could it be useful today? Yale J Biol Med. 2013 Dec 13;86(4):555-70.

Reference Type BACKGROUND
PMID: 24348219 (View on PubMed)

Large M, Hehlgans S, Reichert S, Gaipl US, Fournier C, Rodel C, Weiss C, Rodel F. Study of the anti-inflammatory effects of low-dose radiation: The contribution of biphasic regulation of the antioxidative system in endothelial cells. Strahlenther Onkol. 2015 Sep;191(9):742-9. doi: 10.1007/s00066-015-0848-9. Epub 2015 Jun 8.

Reference Type BACKGROUND
PMID: 26051282 (View on PubMed)

Clayton B. Hess, MD, MPH, and Mohammad K. Khan, MD, PhD, "Low dose chest radiation for COVID-19 patients" Winship Emory News post, April 27, 2020

Reference Type BACKGROUND

Kirkby C, Mackenzie M. Is low dose radiation therapy a potential treatment for COVID-19 pneumonia? Radiother Oncol. 2020 Jun;147:221. doi: 10.1016/j.radonc.2020.04.004. Epub 2020 Apr 6. No abstract available.

Reference Type BACKGROUND
PMID: 32342871 (View on PubMed)

Kefayat A, Ghahremani F. Low dose radiation therapy for COVID-19 pneumonia: A double-edged sword. Radiother Oncol. 2020 Jun;147:224-225. doi: 10.1016/j.radonc.2020.04.026. Epub 2020 Apr 20. No abstract available.

Reference Type BACKGROUND
PMID: 32342874 (View on PubMed)

Stefano M Magrini, Prof et al. COVID-19 Pneumonitis Low Dose Lung Radiotherapy (COLOR-19). ClinicalTrials.gov Identifier: NCT04377477

Reference Type BACKGROUND

Other Identifiers

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IRCT20200509047366N1

Identifier Type: REGISTRY

Identifier Source: secondary_id

23568

Identifier Type: -

Identifier Source: org_study_id