Need for caution in the diagnosis of radiation pneumonitis during the COVID-19 pandemic Research Letter

Authors: Shaverdian, N.; Shepherd, A. F.; Rimner, A.; Wu, A. J.; Simone, C. B. 2nd; Gelblum, D. Y.; Gomez, D. R.
Title: Need for caution in the diagnosis of radiation pneumonitis during the COVID-19 pandemic
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 radiation therapy with clinical and imaging features that overlap with those of 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 March 1, 2020. All patients underwent COVID-19 qualitative RNA testing. Results: Four patients with clinical suspicion for RP were assessed. Three out of 4 patients tested positive for COVID-19. All patients presented with symptoms of cough and dyspnea. Two patients had a fever, of whom only 1 tested positive for COVID-19. Two patients started on an empirical 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 empirical corticosteroids and for careful attention to be paid to chest CT imaging to prevent potential exacerbation of COVID-19 in these high-risk patients. © 2020 The Author(s)
Keywords: adult; clinical article; aged; middle aged; disease course; case report; cisplatin; cancer combination chemotherapy; cancer patient; cancer radiotherapy; drug megadose; carboplatin; computer assisted tomography; etoposide; clinical assessment; coughing; dyspnea; fever; hypoxia; salbutamol; rna; symptom; hospitalization; lung adenocarcinoma; radiation dose fractionation; conservative treatment; corticosteroid; pemetrexed; radiation field; radiation pneumonia; chemoradiotherapy; epidemic; small cell lung cancer; non small cell lung cancer; deterioration; thorax; decreased appetite; lung injury; pandemic; corticosteroid therapy; re-irradiation; human; male; female; priority journal; article; atezolizumab; coronavirus disease 2019
Journal Title: Advances in Radiation Oncology
Volume: 5
Issue: 4
ISSN: 2452-1094
Publisher: Elsevier Inc.  
Date Published: 2020-07-01
Start Page: 617
End Page: 620
Language: English
DOI: 10.1016/j.adro.2020.04.015
PROVIDER: scopus
PMCID: PMC7199721
PUBMED: 32377597
Notes: Article -- Export Date: 1 September 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Daphna Y Gelblum
    176 Gelblum
  2. Daniel R Gomez
    156 Gomez
  3. Andreas Rimner
    459 Rimner
  4. Abraham Jing-Ching Wu
    341 Wu
  5. Charles Brian Simone
    101 Simone