RESULTS
Eighteen patients with median age of 64±9.4 were included. There was
male predominance (male n=16, female n=2). Among cases 13 of them was
non-small cell lung cancer (NSCLC) (including 8 squamous cell and 5
adenocarcinoma) and 5 of them was small cell lung cancer (SCLC).
Distribution of TNM stages was; there were 10 patients with stage IV, 6
patients with stage III, and 2 patients with early stages. Number of
patients receiving chemotherapy was 9 (50%). Among these only one
patient was under adjuvant therapies. Other treatments were as follows;
palliative cranial radiotherapy (RT) for 1 patient, best supportive care
for 3 patients, chemo-radiotherapy for 2 patients, immunotherapy for 1
patient and 2 patients were in process of follow-up after completion of
planned treatment (Table 1).
The most common symptom was shortness of breath (n=14, 77.8%), followed
by fever (n=10, 55.6%). Five patients had cough along with other
symptoms. But in 16 patients (88.9%), many respiratory symptoms, at
least two, were present together. All patients had fatigue, while 3
patients had severe myalgia (Table 1).
According to the results of the radiological evaluation, 14 (77.8%)
patients had pathology on chest X-ray (e.g. consolidation, pleural
effusion, cavity or solid opacities). Findings confirmed on computed
thorax tomography (CTT) were as follows: Consolidation (n=8, 44.4%),
ground glass opacities (n=8, 44.4%) and thoracic
tumour/mediastinal-hilar lymphadenopathy (n=3, 16.7%). Five patients
(27.8%) had pleural effusion on CTT. The parenchymal findings of these
5 patients with pleural effusion were in the form of consolidation or
secondary changes to the tumour. No pleural effusion was detected in
patients having ground glass opacities on CTT (Table 1).
Hypoxia was seen in 11 patients (61.1.%). In 12 patient’s elevation of
LDH (median=302±197) and lymphopenia (median=1055±648) was observed
(Table 1).
There were 5 (27.7%) highly suspected cases for new coronavirus
requiring nasopharyngeal swap. None of them was positive for COVID-19.
Two of these 5 patients received COVID-19 specific treatment while
differential diagnosis was ongoing (Table 2, case number 1 and 3).
Considering radiological features of these patients, 4 of them had
ground glass opacities on CTT. One patient had consolidation and tumour
progression on CTT but due to fever that does not respond to
broad-spectrum antibiotics he was required COVID-19 PCR test and
resulted negative (Table 2, case number 5). Gram negative bacillus
growth in the sputum was the most common microbiological features.
Among covid-19 suspected patients (n=5), 3 of them responded to
broad-spectrum antibiotic therapy. In one case (Table 2, case number 2)
with SCLC receiving immunotherapy following chemo-radiotherapy within
the scope of international, multi-centre clinical trial, he was
diagnosed with radiation pneumonitis after excluding COVID-19 with
negative nasopharyngeal swab. He responded well to metil-prednisolone
treatment (Figure 1). For 2 patients (Table 2, case number 1 and 3),
although 3 PCR results were negative, they were hospitalized in the
isolated service and significant clinical and radiological results were
obtained with covid-specific treatment (Figure 2 and 3).
During epidemic we were tend to avoid unnecessary minimal invasive
procedures like bronchoscopy or endobronchial ultrasound (EBUS). Only 1
patient required bronchoscopy to obtain intra-bronchial secretion
clearance and his bronchial lavage culture was positive for