Hollings researcher finds surprising results in COVID-19-positive lung cancer patients

Protecting cancer patients from COVID-19 and its new variants continues to be a priority at MUSC Hollings Cancer Center. Hollings researcher and radiation oncologist Graham Warren, M.D., Ph.D., published a new study in the Journal of Thoracic Oncology detailing new findings and early markers of COVID-19 in lung cancer patients.

In the study, Warren pooled CT scans from several institutions around the world selected from patients who had undergone image-guided radiotherapy and developed COVID-19 during treatment. In the majority of cases studied, the scans revealed the presence of infiltrates, which refers to the hazy gray areas that can show up on scans of the lungs and serves as a marker of COVID-19 before the patient showed any symptoms.

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

In the study, researchers reviewed the scans of nine lung cancer patients from Turkey, Spain, Belgium, Egypt and the United States who had tested positive for COVID-19. Warren said, surprisingly, that eight out of the nine patient scans revealed the presence of infiltrates in the lungs.

“These findings are extremely important,” he said. “If a doctor notices something on the patient’s scan, they can have them tested for COVID-19 or ask them how they are doing. This gives us the opportunity to identify patients who may have a higher risk of having COVID-19, whether they are symptomatic or not.”

Identifying COVID-19 is especially important in cancer settings because patients receiving cancer treatment are at higher risk for severe complications and death from COVID. Warren said that although chemotherapy and pneumonia can also cause infiltrates to form in the lungs, the finding in this international study is significant.

“These findings directly align with strategies to identify optimal cancer treatment strategies coupled 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.”
— Dr. Graham Warren

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

With the number of new cases surging in some areas due to highly contagious variants, Warren said that further studies are needed to understand more fully the early markings of the virus and ways to protect those most at risk. At Hollings, positive COVID-19 cases among cancer patients are handled on an individual case basis.

“We have to deal with the patient and his or her diagnosis and also keep in mind exposure to other people,” he said. “If a patient develops COVID-19 during cancer treatment, then we try and treat that person at the end of the day, having staff wear appropriate protective clothing to reduce the risk of exposure to others. If patients show symptoms, we can modify treatment or stop treatment if needed.”

According to Warren, two recommendations resulted from the study. First, radiation oncologists and radiation departments should strongly consider reviewing image guidance for new pulmonary infiltrates and consider immediate COVID-19 testing in patients who show new infiltrates even with no obvious COVID-19 symptoms. Second, substantially more data is needed to determine the sensitivity and specificity of these findings and refine this approach in standard clinical care.

It is likely that COVID-19 will remain an important consideration for society and medical care. It’s also likely that variants will continue to evolve, and cases may present with different symptoms and imaging findings, he said. It will be important to continue monitoring patients during cancer treatment for years to come.

“With current COVID-19 variants and symptoms, these imaging findings could be extremely useful to help to minimize risk and infection,” said Warren. “These findings directly align with strategies to identify optimal cancer treatment strategies coupled 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.”

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