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