Low Dose Whole Lung Radiotherapy for Older Patients With COVID-19 Pneumonitis

Background: Coronavirus disease 19 (COVID-19) carry a high mortality rate among older
patients and minorities such as ethnic Africans and Latinos. The chronic baseline systemic
inflammation of older patients and minorities may make them more vulnerable to the cytokines
storm generated by the viral infection in addition to preexisting co-morbidity.

Even though multiple organs failure result from the cytokine storm, pneumonia and respiratory
failure often lead to death. Low dose whole lung radiotherapy (LDWLRT) may modulate the
inflammatory response and may decrease the need for artificial ventilation, thus improving
mortality rate.

Methods: A phase I-II prospective trials enrolling 500 patients, 65 years old or older from
26 countries will be conducted to investigate the impact of LDWLRT on mortality rate of
COVID-19 patients. The patients who will be selected would have developed pneumonias but did
not require artificial ventilation. These patients will be followed for a year after
receiving this treatment. Their physical activities will be monitored through the ordinal
scale and will be correlated with their cytokines status and oxygen saturation rate to assess
the impact of the residual inflammation on their daily life. Mortality rates between
different ethnic group will be compared and correlated with their cytokines response to the
virus and number of co-morbidities.

Discussion and importance of the study: We postulate that LDWLRT may improve survival rates
of all patients by preventing the need for artificial ventilation which is associated with a
high mortality. The inflammatory response between different ethnic groups before and
following radiotherapy will be valuable to serve as baseline for future prospective pandemic
studies as it has not been reported before.