低剂量放疗治疗8例重型/危重型新冠肺炎的初步临床观察

Preliminary clinical observations of low⁃dose radiotherapy for eight cases of severe/critical COVID⁃19

目的探讨全肺低剂量放疗(LDRT)治疗重型/危重型新型冠状病毒(COVID⁃19)肺炎的疗效和不良反应。方法本研究为单臂Ⅰ期临床研究,对2023年1月至6月南通大学附属江阴医院收治的经内科治疗后病情恶化或无改善的8例重型/危重型新型COVID⁃19肺炎患者行全肺LDRT。患者取仰卧或俯卧位,前后对穿照射,剂量权重为1∶1,全肺LDRT剂量0.5~1.5 Gy。分析患者放疗前后氧合状况、炎症指标和影像学变化,观察患者急性放射性不良反应。结果LDRT后1周,7例(87.5%)患者的SaO_(2)/FiO_(2)或PaO_(2)/FiO_(2)指标上升,7例(87.5%)患者C反应蛋白(CRP)、白介素6(IL⁃6)等炎性指标下降,胸部CT/胸片扫描显示5例(62.5%)肺部炎症受累范围显著减少。未观察到明显急性放射性不良反应。结论对内科治疗效果欠佳的重型/危重型新型COVID⁃19肺炎患者进行全肺0.5~1.5 Gy剂量的LDRT治疗,有助于降低炎症指标,改善临床症状,促进炎症吸收且无明显急性不良反应。

Objective To investigate the efficacy and adverse reactions of whole⁃lung low⁃dose radiotherapy(LDRT)in patients with severe/critical coronavirus disease 2019(COVID⁃19).Methods Eight patients with severe/critical COVID⁃19 treated in the Jiangyin Hospital Affiliated to Nantong University from January to June 2023 who were treated with whole⁃lung LDRT after deteriorating or failing to improve post⁃medical treatment were enrolled in this single⁃arm phase Ⅰ clinical trial.They received anterior⁃posterior penetrating radiation in a supine or prone position,with a total dose range from 0.5 to 1.5 Gy and a dose weight ratio of 1∶1.The oxygenation status,inflammatory markers,and imaging changes before and after radiotherapy were analyzed,and patients were followed up for acute radiation⁃induced adverse reactions.Results One week after LDRT,the SaO_(2)/FiO_(2) or PaO_(2)/FiO_(2) indices increased in seven patients(87.5%),inflammatory markers such as C⁃reactive protein(CRP)and interleukin⁃6(IL⁃6)decreased in seven patients(87.5%),and chest CT/chest radiographs revealed a significant reduction in the extent of pneumonia involvement in 5 patients(62.5%).No evident acute radiation⁃related adverse reactions were observed.Conclusions Whole⁃lung LDRT with a dose range from 0.5 to 1.5 Gy can reduce inflammatory markers,improve clinical symptoms,and promote inflammatory absorption in patients with severe/critical COVID⁃19 who responded poorly to medical treatment while not inducing acute adverse reactions.