Low dose radiotherapy for benign painful skeletal disorders –The typical treatment for the elderly patient?

Publication date: Available online 18 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Oliver Micke, M. Heinrich Seegenschmiedt, Irenaeus A. Adamietz, Guenter Kundt, Khashayar Fakhrian, Ulrich Schaefer, Ralph Muecke
PurposeThe aim of this prospective analysis was to evaluate the short-term and long-term efficacy of low dose radiotherapy (RT) for calcaneodynia, achillodynia, painful gonarthrosis, and painful bursitis trochanterica in eldely patients with an age of => 70 years.MethodsBetween October 2011 and October 2013, patients with an age of => 70 years with painful degenerative disorders of joints were recruited for a prospective trial. Single doses of 0.5 - 1.0 Gy and a total dose of 6.0 Gy per series were used. Pain was measured before and right after RT (early response) with a 10 scale visual analogue scale (VAS. Additionally, pain relief was measured with the four-scale pain score according to "von Pannewitz" (VPS) immediately on completion of RT and during follow-up. We defined a good response as complete pain relief and markedly improved.Results166 evaluable patients with a mean age of 76.6 years (70-90) with calcaneodynia (n=51), achillodynia (n=8), painful gonarthrosis (n=80), and painful bursitis trochanterica (n=27) were recruited. The mean VAS value before treatment was 6.38 and immediately on completion of RT 4.49(p<0.001). Concerning the VPS immediately on completion of RT, 6 patients were free of pain, 56 were much improved, 47 reported slight improvement, and 57 experienced no change. After a median follow-up of 29 months, 109 patients could be reached for evaluation of follow up results.33 patients were free of pain, 21 had marked improvement, 18 had some improvement, and 37 experienced no change. Therefore, a good response immediately on completion of RT could be achieved in 62/166 patients, and with the follow up in 54/109 patients(p=0.001).ConclusionsLow dose RT is a very effective treatment for the management of painful degenerative disorders of joints in the elderly. Low dose radiotherapy offers a low-risk, genuinely conservative, non-invasive therapeutic alternative for elderly patients.

Teaser

Low dose RT is a very effective treatment for the management of painful degenerative skeletal disorders in the elderly. Due to the delayed onset of analgesic effects low dose RT results in a significantly improved long-term efficacy in comparison to the results immediately after RT. In view of the ageing population and the corresponding increase in painful degenerative disorders of joints, low dose radiotherapy offers a low-risk, genuinely conservative, non-invasive therapeutic alternative for elderly patients.


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