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Computed Tomography Tips During Lung Cancer Radiation Therapy May Identify COVID-19 Patients

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Computed tomography (CT) -based image guidance during radiation therapy could be a method of identifying patients who require a full workup for COVID-19, according to the results of an analysis of lung cancer patients published in the Journal of Thoracic Oncology.

“These findings are extremely important,” said lead author of the study Graham Warren, MD, PhD, professor at the Medical University of South Carolina, in a press release. “If a doctor notices something on the patient’s CT scan, they can have them tested for COVID-19 or ask them how they are doing. This gives us the ability to identify patients who may have a higher risk of having COVID-19, whether they are symptomatic or not. “

Screening for exposure to COVID-19, especially for cancer patients on active treatment, has become a priority during the pandemic. Following 2 case reports of imaging results during routine CT image-guided radiation therapy examinations, investigators set out to determine if there is a correlation between the appearance of new lung infiltrates detected during radiation therapy in patients diagnosed with COVID-19.

To that end, investigators compiled data from anonymized case reports of patients who developed biochemically confirmed COVID-19 during radiation therapy through an online portal. The data included information on the patient’s sex, age, cancer diagnosis and treatment, as well as the diagnosis and outcome of COVID-19.

“Lung cancer patients receiving radiation are unique because they already have routine lung scans,” Warren said. “We can use the radiation setup already in place to identify the risk of COVID-19, and we can achieve this without significant changes to our standard radiation therapy procedures. “

During the series, coplanar CT imaging was performed on each patient to identify the presence or absence of opacities or ground glass infiltrates.

“We want to try to identify very quickly a cancer patient’s risk of having COVID-19 because these patients have a higher risk of complications and mortality,” Warren said. “By using tests to uncover potential positive cases of COVID-19 early on, we can help reduce the risk of exposure to other patients as well as facilitate earlier diagnosis and treatment for patients with COVID. “

Seven cases were submitted by Turkey, Spain, Belgium, Egypt and the United States. These cases were supplemented by the results and imaging of 2 patients reported by Suppli et al and McGinnis et al.

The median age of the patients was 63.3 years.

The 9 patients included 4 women and 1 patient with metastatic disease. All 9 patients had lung cancer, including 4 cases of squamous cell carcinoma and 5 cases of adenocarcinoma.

All of the patients had confirmed COVID-19 diagnoses using tests based on the polymerase chain reaction or nasopharyngeal swabs.

Regarding the characteristics of cancer treatment, 7 patients received chemotherapy and 1 patient was included in a clinical trial evaluating immunotherapy plus stereotaxic ablative radiotherapy.

The results showed that abnormalities indicative of opacities or ground glass infiltrates were identified in 8 of the 9 patients analyzed. The ninth patient had no obvious opacities or infiltrates on the submitted images.

Three patients completed the scheduled course of radiation therapy; the rest of the patients stopped or stopped treatment.

Six patients presented with symptoms, with fever being the most common symptom in all 6 patients.

Seven patients were hospitalized, including 1 patient who was hospitalized without symptoms due to the standard local protocol.

At the date of data submission, 2 patients had died.

“With the current variants and symptoms of COVID-19, these imaging results could be extremely helpful in helping to minimize risks and infections,” Warren said. “These findings align directly with strategies to identify optimal cancer treatment strategies associated with harm reduction strategies for COVID-19. These simple findings can reduce risk and exposure and can immediately improve the lives of cancer patients during cancer treatment, Warren concluded.


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