Department of Radiation Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Int J Radiat Oncol Biol Phys. 2022 Aug 1;113(5):946-959. doi: 10.1016/j.ijrobp.2022.04.043. Epub 2022 May 7.
Studies dating back to a century ago have reported using low-dose radiation therapy for the treatment of viral and bacterial pneumonia. In the modern era, since the COVID-19 pandemic began, several groups worldwide have researched the applicability of whole lung irradiation (WLI) for the treatment of COVID-19. We aimed to bring together the results of these experimental studies.
We performed a systematic review and meta-analysis searching PubMed and Scopus databases for clinical trials incorporating WLI for the treatment of patients with COVID-19. Required data were extracted from each study. Using the random-effects model, the overall pooled day 28 survival rate, survival hazard ratio, and intubation-free days within 15 days after WLI were calculated, and forest plots were produced.
Ten studies were identified, and eventually, 5 were included for meta-analysis. The overall survival hazard ratio was calculated to be 0.85 (0.46-1.57). The pooled mean difference of intubation-free days within 15 days after WLI was 1.87, favoring the WLI group (95% confidence interval, -0.02 to 3.76). The overall day 28 survival rate of patients receiving WLI for the 9 studies with adequate follow-up data was 74% (95% confidence interval, 61-87). Except for 2 studies, the other 8 studies were assessed to have moderate to high risk of bias, and there were many differences among the designs of the studies, included patients, primary endpoints, outcome measurement methods, and reporting of the results.
Despite a mild improvement in intubation-free days, WLI had no significant effect on patients' overall survival. Currently, we cannot recommend routine use of WLI for the treatment of patients with moderate-to-severe COVID-19.
早在一个世纪以前，就有研究报告称低剂量放射疗法可用于治疗病毒和细菌性肺炎。在现代，自 COVID-19 大流行开始以来，全球有几个研究小组研究了全肺照射（WLI）治疗 COVID-19 的适用性。我们旨在汇集这些实验研究的结果。
我们在 PubMed 和 Scopus 数据库中进行了系统评价和荟萃分析，检索了纳入 WLI 治疗 COVID-19 患者的临床试验。从每项研究中提取所需数据。使用随机效应模型，计算 WLI 后第 28 天的总生存率、生存危险比和 15 天内无插管天数，并生成森林图。
确定了 10 项研究，最终有 5 项研究被纳入荟萃分析。计算出的总体生存率危险比为 0.85（0.46-1.57）。WLI 后 15 天内无插管天数的汇总平均差异为 1.87，有利于 WLI 组（95%置信区间，-0.02 至 3.76）。有足够随访数据的 9 项研究中接受 WLI 的患者的第 28 天总生存率为 74%（95%置信区间，61-87）。除了 2 项研究外，其他 8 项研究被评估为存在中度至高度偏倚风险，并且这些研究的设计、纳入患者、主要终点、结果测量方法和报告存在许多差异。
尽管无插管天数略有改善，但 WLI 对患者的总体生存率没有显著影响。目前，我们不能推荐常规使用 WLI 治疗中重度 COVID-19 患者。
