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DEGRO practical guidelines for the radiotherapy of non-malignant disorders – Part IV

Symptomatic functional disorders

DEGRO-S2e-Leitlinie für die Strahlentherapie von gutartigen Erkrankungen – Teil IV

Symptomatische funktionelle Erkrankungen

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Abstract

Purpose

To summarize the updated DEGRO consensus S2e guideline recommendations for the treatment of benign symptomatic functional disorders with low-dose radiotherapy.

Materials and methods

This overview reports on the role of low-dose radiotherapy in the treatment of functional disorders in cases of heterotopic ossification (HO) and Graves orbitopathy (GO). The most relevant aspects of the DEGRO S2e Consensus Guideline “Radiation Therapy of Benign Diseases 2014” regarding diagnostics, treatment decision, dose prescription, as well as performance of radiotherapy and results are summarized.

Results

For both indications (HO, GO), retrospective and some prospective analyses have shown remarkable effects in terms of symptom relief. Nevertheless, the level of evidence (LoE) and the grade of recommendation (GR) vary: LoE 1–2 and GR A-B (HO), LoE 2 and GR B (GO).

Conclusion

Low-dose radiotherapy for benign symptomatic functional disorders has proven to be effective, according to different authors, for 25–100 % of the patients studied and therefore it may be a reasonable prophylactic and therapeutic option if noninvasive or invasive methods have been used without persistent success.

For HO, a single-fraction dose of 7–8 Gy or fractionated radiation with five fractions of 3.5 Gy is recommended. For GO, single-fraction doses of 0.3–2.0 Gy, and total doses of 2.4–20 Gy/series, applied in one daily fraction are recommended.

Zusammenfassung

Zielsetzung

Zusammenfassung der Empfehlungen der DEGRO-S2e-Leitlinie zur Niedrigdosis-Radiotherapie von gutartigen symptomatischen funktionellen Erkrankungen.

Material und Methoden

Die vorliegende Leitlinie berichtet über die Bedeutung der Niedrigdosis-Radiotherapie in der Behandlung von funktionellen Erkrankungen, in diesem Fall von heterotoper Ossifikation (HO) und endokriner Orbitopathie (EO). Es werden die wichtigsten Aspekte der aktuellen DEGRO-S2e-Konsensusleitlinie „Strahlentherapie gutartiger Erkrankungen 2014“ bezüglich Diagnostik, Therapieentscheidungen, Dosisempfehlungen und Empfehlungen zur Durchführung der Radiotherapie zusammengefasst.

Ergebnisse

Für beide Entitäten (HO, EO) wurde in zahlreichen retrospektiven und einigen prospektiven Untersuchungen ein bemerkenswerter Effekt der Niedrigdosis-Radiotherapie im Sinne einer Symptomreduktion beschrieben. Je nach Entität wurden verschiedene Evidenzlevel (LoE) festgestellt, so dass unterschiedliche Empfehlungsgrade (GR) für den Einsatz der Radiotherapie ausgesprochen wurden: LoE 1–2 und GR A–B (HO), LoE 2 und GR B (EO).

Schlussfolgerung

Die Niedrigdosis-Radiotherapie von benignen symptomatischen funktionellen Erkrankungen ist nach Ansicht verschiedener Autoren bei einem Anteil von 25–100 % der untersuchten Patienten effektiv und ist eine gut begründbare Therapieoption für Patienten, bei denen konservative oder operative Verfahren zu keiner anhaltenden Verbesserung geführt haben. Für die HO wird die Einzeitbestrahlung mit 7–8 Gy oder die fraktionierte Bestrahlung mit 5 × 3,5 Gy empfohlen. Für die EO werden Einzeldosen von 0,3–2,0 Gy und Gesamtdosen von 2,4–20 Gy/Serie mit täglicher Bestrahlung befürwortet.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany

    Gabriele Reinartz M.D. & Hans Theodor Eich M.D.

  2. Department of Radiotherapy, University Hospital Regensburg, Regensburg, Germany

    Fabian Pohl M.D.

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  1. Gabriele Reinartz M.D.
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  2. Hans Theodor Eich M.D.
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  3. Fabian Pohl M.D.
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German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD)

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Correspondence to Gabriele Reinartz M.D..

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Conflict of interest

G. Reinartz, H.T. Eich, F. Pohl, and the German Cooperative Group on Radiotherapy for Benign Diseases state that there are no conflicts of interest.

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Reinartz, G., Eich, H., Pohl, F. et al. DEGRO practical guidelines for the radiotherapy of non-malignant disorders – Part IV. Strahlenther Onkol 191, 295–302 (2015). https://doi.org/10.1007/s00066-014-0789-8

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