Need for Caution in the Diagnosis of Radiation Pneumonitis in the COVID-19 Pandemic (DOI: 10.1016/j.adro.2020.04.015)

Publication Metadata

DOI	10.1016/j.adro.2020.04.015
PubMedID	32377597
PMCID	PMC7199721
PubTator	https://www.ncbi.nlm.nih.gov/research/pubtator/?view=docsum&query=PMC7199721
Sections in this Publication
Section	Section 1: Introduction (from DOI: 10.1016/j.adro.2020.04.015)
Section	Section 2: Methods (from DOI: 10.1016/j.adro.2020.04.015)
Section	Section 3: Results (from DOI: 10.1016/j.adro.2020.04.015)
Section	Section 4: Discussion (from DOI: 10.1016/j.adro.2020.04.015)
Section	References (from DOI: 10.1016/j.adro.2020.04.015)
Author(s) [max 10]
1st	Shaverdian N (1st author of DOI: 10.1016/j.adro.2020.04.015)
2nd	Shepherd A (2nd author of DOI: 10.1016/j.adro.2020.04.015)
3rd	Rimner A (3rd author of DOI: 10.1016/j.adro.2020.04.015)
4th	Wu AJ (4th author of DOI: 10.1016/j.adro.2020.04.015)
6th	Gelblum DY (6th author of DOI: 10.1016/j.adro.2020.04.015)
7th	Gomez DR (7th author of DOI: 10.1016/j.adro.2020.04.015)
Dataset	Pubtator Central BioC-JSON formatted article files

Research article published in:
Adv Radiat Oncol; 2020 May 05 . DOI: http://doi.org/10.1016/j.adro.2020.04.015

Abstract

Purpose
Patients with cancer are at high-risk for mortality from coronavirus-disease 2019 (COVID-19). Radiation pneumonitis (RP) is a common toxicity of thoracic radiotherapy with overlapping clinical and imaging features with COVID-19, however, RP is treated with high-dose corticosteroids, which may exacerbate COVID-19-associated lung injury. We reviewed patients who presented with symptoms of RP during the intensification of a regional COVID-19 epidemic to report on their clinical course and COVID-19 testing results.
Methods and Materials
The clinical course and chest computed tomography (CT) imaging findings of consecutive patients who presented with symptoms of RP in March 2020 were reviewed. The first regional COVID-19 case was diagnosed on 3/1/2020. All patients underwent COVID-19 qualitative RNA testing.
Results
Four patients with clinical suspicion for RP were assessed. Three out of four patients tested positive for COVID-19. All patients presented with symptoms of cough and dyspnea. Two patients had a fever, of whom only one tested positive for COVID-19. Two patients started on an empiric high-dose corticosteroid taper for presumed RP, but both had clinical deterioration, and ultimately tested positive for COVID-19 and required hospitalization. Chest CT findings in patients suspected of RP, but ultimately diagnosed with COVID-19 showed ground-glass opacities mostly pronounced outside the radiation field.
Conclusions
As this pandemic continues, patients with symptoms of RP require diagnostic attention. We recommend that patients suspected of RP be tested for COVID-19 before starting empiric corticosteroids and for careful attention be paid to chest CT imaging in order to prevent potential exacerbation of COVID-19 in these high-risk patients.

License

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.