Skip to main content
Top
Published in: Strahlentherapie und Onkologie 12/2019

Open Access 01-12-2019 | Osteoarthrosis | Original Article

Radiotherapy for painful benign skeletal disorders

Results of a retrospective clinical quality assessment

Authors: Nderim Juniku, Oliver Micke, M. Heinrich Seegenschmiedt, Ralph Muecke

Published in: Strahlentherapie und Onkologie | Issue 12/2019

Login to get access

Abstract

Purpose

The aim of this retrospective clinical quality assessment was to evaluate the efficacy of low-dose radiotherapy (RT) for painful benign skeletal disorders.

Methods

Patients with different painful benign skeletal disorders (arthrosis and enthesopathies) were recruited for this retrospective clinical quality assessment between January 2014 and December 2015. RT was applied with a linear accelerator. Single doses of 0.5 Gy (total dose 3.0–5.0 Gy) were used. Pain was measured before and immediately after RT (early response) by a 10-point visual analogue scale (VAS). We defined a VAS score of 0–2 as a good response. Pain relief was measured during follow-up.

Results

A total of 598 evaluable patients (394 females, 204 males) with a mean age of 61.4 years (range 33–81 years) were recruited. The median VAS score was 7.0 (interquartile range [IQR] 2) before treatment and 5.0 (IQR 4) upon completion of RT (p < 0.001). A good response was achieved upon completion of RT in 83 patients (13.9%), with a median follow-up of 38 months (range 29–47 months) in 373 patients (62.4%; p < 0.001). In general, RT had a better effect on enthesopathies than on arthrosis.

Conclusion

Low-dose RT is a very effective treatment for the management of painful benign skeletal disorders. Due to the delayed onset of analgesic effects, low-dose RT results in significantly improved long-term efficacy compared to the results immediately after RT. These findings confirm the results of other retrospective, prospective, and randomized trials.
Literature
1.
go back to reference Seegenschmiedt MH, Micke O, Muecke R, German Cooperative Group on Radiotherapy for Non-malignant Diseases (GCG-BD) (2015) Radiotherapy for nonmalignant disorders: state of the art and update of the evidence-based practice guidelines. Br J Radiol 88:20150080CrossRef Seegenschmiedt MH, Micke O, Muecke R, German Cooperative Group on Radiotherapy for Non-malignant Diseases (GCG-BD) (2015) Radiotherapy for nonmalignant disorders: state of the art and update of the evidence-based practice guidelines. Br J Radiol 88:20150080CrossRef
2.
go back to reference Reichl B, Block A, Schaefer U, Bert C, Mueller R, Jung H, Roedel F, German Working Group on Radiotherapy in Germany(GCG-BD) (2015) DEGRO practical guidelines for radiotherapy of non-malignant disorders: part I: physical principles, radiobiological mechanisms, and radiogenic risk. Strahlenther Onkol 191:701–709CrossRef Reichl B, Block A, Schaefer U, Bert C, Mueller R, Jung H, Roedel F, German Working Group on Radiotherapy in Germany(GCG-BD) (2015) DEGRO practical guidelines for radiotherapy of non-malignant disorders: part I: physical principles, radiobiological mechanisms, and radiogenic risk. Strahlenther Onkol 191:701–709CrossRef
3.
go back to reference Bortz J, Doering N (2006) Forschungsmethoden und Evaluation für Human- und Sozialwissenschaftler. Springer, Heidelberg, p 177. ISBN 3‑540-33305‑3CrossRef Bortz J, Doering N (2006) Forschungsmethoden und Evaluation für Human- und Sozialwissenschaftler. Springer, Heidelberg, p 177. ISBN 3‑540-33305‑3CrossRef
4.
go back to reference Ott OJ, Niewald M, Weitmann HD, Jacob I, Adamietz IA, Schaefer U, Keilholz L, Heyd R, Muecke R, German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) (2015) DEGRO guidelines for the radiotherapy of non-malignant disorders: part II: painful degenerative skeletal disorders. Strahlenther Onkol 191:1–6CrossRef Ott OJ, Niewald M, Weitmann HD, Jacob I, Adamietz IA, Schaefer U, Keilholz L, Heyd R, Muecke R, German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) (2015) DEGRO guidelines for the radiotherapy of non-malignant disorders: part II: painful degenerative skeletal disorders. Strahlenther Onkol 191:1–6CrossRef
5.
go back to reference Ott OJ, Jeremias C, Gaipl US, Frey B, Schmidt M, Fietkau R (2015) Radiotherapy for benign achillodynia: long-term results of the Erlangen dose optimization trial. Strahlenther Onkol 191:979–984CrossRef Ott OJ, Jeremias C, Gaipl US, Frey B, Schmidt M, Fietkau R (2015) Radiotherapy for benign achillodynia: long-term results of the Erlangen dose optimization trial. Strahlenther Onkol 191:979–984CrossRef
6.
go back to reference Ott OJ, Jeremias C, Gaipl US, Frey B, Schmidt M, Fietkau R (2014) Radiotherapy for benign calcaneodynia: long-term results of the Erlangen dose optimization (EDO) trial. Strahlenther Onkol 190:671–675CrossRef Ott OJ, Jeremias C, Gaipl US, Frey B, Schmidt M, Fietkau R (2014) Radiotherapy for benign calcaneodynia: long-term results of the Erlangen dose optimization (EDO) trial. Strahlenther Onkol 190:671–675CrossRef
7.
go back to reference Niewald M, Seegenschmiedt MH, Micke O, Graeber S, Muecke R, Schaefer V, Scheid C, Fleckenstein J, Licht N, Ruebe C, German Cooperative Group on Radiotherapy for Benign Diseases (2012) Randomized, multicenter trial on the effect of radiation therapy on plantar fasciitis (painful heel spur) comparing a standard dose with a very low dose: mature results after 12 months’ followup. Int J Radiat Oncol Biol Phys 84:e455–462CrossRef Niewald M, Seegenschmiedt MH, Micke O, Graeber S, Muecke R, Schaefer V, Scheid C, Fleckenstein J, Licht N, Ruebe C, German Cooperative Group on Radiotherapy for Benign Diseases (2012) Randomized, multicenter trial on the effect of radiation therapy on plantar fasciitis (painful heel spur) comparing a standard dose with a very low dose: mature results after 12 months’ followup. Int J Radiat Oncol Biol Phys 84:e455–462CrossRef
8.
go back to reference Muecke R, Seegenschmiedt MH, Heyd R, Schaefer U, Prott FJ, Glatzel M, Micke O, German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) (2010) Radiotherapy in painful gonarthrosis. Results of a national patterns-of-care study. Strahlenther Onkol 186:7–17CrossRef Muecke R, Seegenschmiedt MH, Heyd R, Schaefer U, Prott FJ, Glatzel M, Micke O, German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) (2010) Radiotherapy in painful gonarthrosis. Results of a national patterns-of-care study. Strahlenther Onkol 186:7–17CrossRef
9.
go back to reference Muecke R, Micke O, Reichl B, Heyder R, Prott FJ, Seegenschmiedt MH, Glatzel M, Schneider O, Schaefer U, Kundt G (2007) Demographic, clinical and treatment related predictors for event-free probability following low-dose radiotherapy for painful heel spurs—a retrospective multicenter study of 502 patients. Acta Oncol 46:239–246CrossRef Muecke R, Micke O, Reichl B, Heyder R, Prott FJ, Seegenschmiedt MH, Glatzel M, Schneider O, Schaefer U, Kundt G (2007) Demographic, clinical and treatment related predictors for event-free probability following low-dose radiotherapy for painful heel spurs—a retrospective multicenter study of 502 patients. Acta Oncol 46:239–246CrossRef
10.
go back to reference Kaltenborn A, Carl UM, Hinsche T, Nitsche M, Herrmann RM (2017) Low-dose external beam radiotherapy for greater trochanteric pain syndrome-target volume definition and treatment outcome. Strahlenther Onkol 193:260–268CrossRef Kaltenborn A, Carl UM, Hinsche T, Nitsche M, Herrmann RM (2017) Low-dose external beam radiotherapy for greater trochanteric pain syndrome-target volume definition and treatment outcome. Strahlenther Onkol 193:260–268CrossRef
11.
go back to reference Ott OJ, Hertel S, Gaipl US, Frey B, Schmidt M, Fietkau R (2014) The Erlangen dose optimization trial for radiotherapy of benign painful shoulder syndrome. Long-term results. Strahlenther Onkol 190:394–398CrossRef Ott OJ, Hertel S, Gaipl US, Frey B, Schmidt M, Fietkau R (2014) The Erlangen dose optimization trial for radiotherapy of benign painful shoulder syndrome. Long-term results. Strahlenther Onkol 190:394–398CrossRef
12.
go back to reference Micke O, Seegenschmiedt MH, Adamietz IA, Fakhrian K, Schaefer U, Muecke R (2017) Low-dose radiation therapy for benign painful skeletal disorders: the typical treatment for the elderly patient? Int J Radiat Oncol Biol Phys 98:958–963CrossRef Micke O, Seegenschmiedt MH, Adamietz IA, Fakhrian K, Schaefer U, Muecke R (2017) Low-dose radiation therapy for benign painful skeletal disorders: the typical treatment for the elderly patient? Int J Radiat Oncol Biol Phys 98:958–963CrossRef
13.
go back to reference Micke O, Ugrak E, Bartmann S, Adamietz IA, Schaefer U, Bücker R, Kisters K, Seegenschmiedt MH, Fakhrian K, Muecke R (2018) Radiotherapy for calcaneodynia, achillodynia, painful gonarthrosis, bursitis trochanterica, and painful shoulder syndrome—Early and late results of a prospective clinical quality assessment. Radiat Oncol 13:71CrossRef Micke O, Ugrak E, Bartmann S, Adamietz IA, Schaefer U, Bücker R, Kisters K, Seegenschmiedt MH, Fakhrian K, Muecke R (2018) Radiotherapy for calcaneodynia, achillodynia, painful gonarthrosis, bursitis trochanterica, and painful shoulder syndrome—Early and late results of a prospective clinical quality assessment. Radiat Oncol 13:71CrossRef
14.
go back to reference Pieretti S, Di Giannuario A, Di Giovannandrea R, Marzoli F, Piccaro G, Minosi P, Aloisi AM (2016) Gender differences in pain and its relief. Ann Ist Super Sanita 52:184–189PubMed Pieretti S, Di Giannuario A, Di Giovannandrea R, Marzoli F, Piccaro G, Minosi P, Aloisi AM (2016) Gender differences in pain and its relief. Ann Ist Super Sanita 52:184–189PubMed
15.
go back to reference Mahler EAM, Minten MJ, Leseman-Hoogenboom MM, Poortmans PMP, Leer JWH, Boks SS, van den Hoogen FHJ, den Broeder AA, van den Ende CHM (2019) Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. Ann Rheum Dis 78:83–90CrossRef Mahler EAM, Minten MJ, Leseman-Hoogenboom MM, Poortmans PMP, Leer JWH, Boks SS, van den Hoogen FHJ, den Broeder AA, van den Ende CHM (2019) Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. Ann Rheum Dis 78:83–90CrossRef
16.
go back to reference Minten MJM, Leseman-Hoogenboom MM, Kloppenburg M, Kortekaas MC, Leer JW, Poortmans PMP, van den Hoogen FHJ, den Broeder AA, van den Ende CHM (2018) Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis Cartilage 26:1283–1290CrossRef Minten MJM, Leseman-Hoogenboom MM, Kloppenburg M, Kortekaas MC, Leer JW, Poortmans PMP, van den Hoogen FHJ, den Broeder AA, van den Ende CHM (2018) Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis Cartilage 26:1283–1290CrossRef
17.
go back to reference Ott OJ, Micke O, Mücke R, Niewald M, Rödel F, Schäfer U, Seegenschmiedt MH, Arenas M, Frey B, Gaipl US, German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) (2018) Low-dose radiotherapy: Mayday, mayday. We’ve been hit! Strahlenther Onkol 195:285–288CrossRef Ott OJ, Micke O, Mücke R, Niewald M, Rödel F, Schäfer U, Seegenschmiedt MH, Arenas M, Frey B, Gaipl US, German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) (2018) Low-dose radiotherapy: Mayday, mayday. We’ve been hit! Strahlenther Onkol 195:285–288CrossRef
Metadata
Title
Radiotherapy for painful benign skeletal disorders
Results of a retrospective clinical quality assessment
Authors
Nderim Juniku
Oliver Micke
M. Heinrich Seegenschmiedt
Ralph Muecke
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 12/2019
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-019-01514-w

Other articles of this Issue 12/2019

Strahlentherapie und Onkologie 12/2019 Go to the issue