Feasibility of Implementing Thoracic Radiation Therapy for COVID-19 Pneumonia

Abstract

Purpose/Objective(s)The value of low dose whole thoracic radiation therapy (LD-WTRT) for SARS-CoV-2 (COVID-19) pneumonia is unknown. Should ongoing clinical trials demonstrate LD-WTRT proves effective for COVID-19 pneumonia recovery, widespread rapid implementation will be helpful globally. Our aim was to outline a pragmatic process that could be implemented successfully in a community hospital.Materials/MethodsTo identify appropriate patients admitted to the hospital with COVID-19 pneumonia, we worked with Nursing Informatics to screen all currently admitted COVID+ patients requiring oxygen supplementation. For patients meeting criteria of the PreVent protocol per chart review, radiation oncologists contacted the hospitalist physician for telehealth consultation with the patient to discuss single dose LD-WTRT. After a patient had confirmed interest in treatment, at time of physical exam, we obtained consent and digitally transferred the signed consent form via secure text to avoid contaminated forms. Chest radiographs were used to estimate AP/PA field size and separation at the carina; diagnostic chest CT data was imported into the treatment planning system for field size and MU calculation before patient arrival, without using the department's CT simulator. Inpatient Nursing transported patients for treatment after clinic hours on a route pre-approved by Infection Control. The treating radiation oncologist and one ‘hot’ radiation therapist assisted with patient set-up supine or prone on the linear accelerator couch. After decontamination, the physician and a ‘cold’ therapist confirmed field size and MU calculations to prepare for treatment delivery. Nursing monitored patient O2 saturation and stayed gowned with the ‘hot’ therapist. After patient departure, Radiation Oncology contacted Facilities for decontamination of the vault before treating cancer patients the following day.ResultsFor the first treated patient, telehealth consultation lasted 40 minutes. In-person exam, evaluation and consent took 60 minutes, of which 30 were for the protocol-required consent form. With the diagnostic CT scan, field design and MU calculations took 20 minutes. Patient arrival to departure took 40 minutes. Once the patient was positioned on the couch, localization, MU confirmation and entry and treatment delivery took 16 minutes.ConclusionWe have developed a process to efficiently provide LD-WTRT for patients with COVID pneumonia that minimizes staff exposure, departmental equipment, and room contamination. Should clinical trials indicate that LD-WTRT helps treat COVID pneumonia patients, this process can work in most hospital-based radiation oncology departments to provide LD-WTRT efficiently and safely. Staff and cancer patient vaccination will further lower the risks of implementing LD-WTRT but is not necessary with careful planning and consultation with infection control.