Section 3: Results (from DOI: 10.1016/j.adro.2020.04.015)
From publication: "Need for Caution in the Diagnosis of Radiation Pneumonitis in the COVID-19 Pandemic" published as Adv Radiat Oncol; 2020 May 05. DOI: https://doi.org/10.1016/j.adro.2020.04.015
Section 3: 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.
Patient 1: A 73-year-old female with an American Joint Committee on Cancer (AJCC) 8th edition T2bN3M0, Stage IIIB, small-cell lung cancer (SCLC) treated with carboplatin/etoposide/atezolizumab and sequential definitive thoracic radiation (56 Gy in 28 fractions due to a large field involving the bilateral hilum). Six weeks after radiation, she developed a non-productive cough, which was initially managed conservatively. One week later her symptoms progressed and she was started on empiric high-dose corticosteroids for presumed RP. One week later, her symptoms of cough and dyspnea progressed, and she presented to the Emergency Department (ED) with hypoxia. She was tested for COVID-19 and was found to be positive. Chest computed tomography (CT) revealed diffuse ground-glass opacities, mostly pronounced outside the radiation field (Figure 1 ).
Patient 2: A 56-year-old male with a T1cN3M0, Stage IIIB, non-small-cell lung cancer (NSCLC) treated with definitive thoracic radiation (60 Gy in 30 fractions) with concurrent cisplatin/pemetrexed. Eleven weeks after radiation, he developed a non-productive cough and mildly increased dyspnea on exertion and was managed conservatively. Approximately four weeks later, he presented with fever and worsening cough and dyspnea. A fever work-up including a standard viral respiratory panel was negative. COVID-19 testing was unavailable at the time. Chest CT imaging revealed mild inflammatory changes within the radiation field, and he was started on empiric high-dose corticosteroids for presumed RP. One week after starting corticosteroids, his symptoms progressed, and he presented to the ED with hypoxia. He was tested for COVID-19 and was found to be positive.
Patient 3: A 66-year-old female with a T1bN2M0, Stage IIIA SCLC treated with definitive twice-daily thoracic radiation (45 Gy in 1.5Gy fractions) with concurrent carboplatin/etoposide. Eight weeks after radiation, she reported a new onset non-productive cough and increased dyspnea requiring increased albuterol use. She denied fever, fatigue or decreased appetite. Out of caution, COVID-19 testing was recommended, which returned positive, and she was not treated for RP.
Patient 4: A 65-year-old female with a history of a T1N2M0, stage IIIA adenocarcinoma of the right lung treated with definitive concurrent chemoradiation in 2006 (59.4 Gy in 33 fractions), who then developed an in-field recurrence and was treated with definitive re-irradiation (60 Gy in 30 fractions) concurrent with cisplatin/pemetrexed followed by consolidative durvalumab. Sixteen weeks after reirradiation, she presented with a progressive non-productive cough and dyspnea. Chest CT imaging demonstrated mild inflammatory-changes within the radiation field, and empiric short-course corticosteroids were prescribed, which initially improved symptoms. After completing an initial short-course of corticosteroids, she presented with fever and worsening cough and dyspnea. COVID-19 testing was recommended which returned negative. She was then started on a high-dose corticosteroid taper for RP, which improved symptoms.
