The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis

Importance of field size

Relevanz der Feldgröße in der Reizbestrahlung bei Rhizarthrose

Relevanz der Feldgröße

Abstract

The purpose of this work was to evaluate the efficacy of low-dose radiotherapy (RT) for thumb carpometacarpal osteoarthritis (rhizarthrosis). The responses of 84 patients (n = 101 joints) were analyzed 3 months after therapy (n = 65) and at 12 months (n = 27). Patients were treated with 6 fractions of 1 Gy, two times a week, with a linear accelerator. At the end of therapy, about 70 % of patients reported a response (partial remission or complete remission), 3 months later about 60 %, and 1 year after treatment 70 %. In univariate regression analysis, higher patient age and field size greater than 6 × 4 cm were associated with response to treatment, while initial increase of pain under treatment was predictive for treatment failure. Duration of RT series (more than 18 days), gender, time of symptoms before RT, stress pain or rest pain, or prior ortheses use, injections, or surgery of the joint were not associated with treatment efficacy. In multivariate regression analysis, only field size and initial pain increase were highly correlated with treatment outcome. In conclusion, RT represents a useful treatment option for patients suffering from carpometacarpal osteoarthritis. In contrast to other benign indications, a larger field size (>6 × 4 cm) seems to be more effective than smaller fields and should be evaluated in further prospective studies.

Zusammenfassung

Wir analysierten den berichteten Therapieeffekt einer protrahiert fraktionierten Schmerzbestrahlung bei 84 Patienten (n = 101 Gelenke, Kontrolluntersuchungen nach 3 Monaten bei n = 65, nach 12 Monaten bei n = 27). Die Patienten wurden 2‑mal pro Woche mit 6 × 1 Gy an einem Linearbeschleuniger bestrahlt. Bei Abschluss der Behandlung gaben ca. 70 % der Patienten eine Verbesserung an (partielle oder komplette Remission), 3 Monate später ca. 60 % und ein Jahr nach der Behandlung 70 %. In der univariaten Regression waren ein höheres Patientenalter und eine Feldgröße über 6 × 4 cm mit einem Therapieansprechen assoziiert, während eine initiale Schmerzverstärkung mit einem Therapieversagen korreliert war. Länge der Therapieserie, Geschlecht, Dauer der Symptome vor Einleitung der Bestrahlung, Schmerzen unter Belastung oder in Ruhe oder vorherige Orthesenversorgung, Injektionen oder Operationen des Gelenks waren hingegen nicht mit dem Therapieerfolg korreliert. In der multivariaten Regression waren nur die Feldgröße und die initiale Schmerzverstärkung prädiktiv für das Therapieergebnis. Die Schmerzbestrahlung ist eine effektive Behandlungsoption für Patienten mit Rhizarthrose. Dabei scheint – im Gegensatz zu anderen benignen Bestrahlungsindikationen – eine Feldgröße über 6 × 4 cm effektiver zu sein als kleinere Felder. Dieser Befund sollte in prospektiven Studien weiter evaluiert werden.

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Correspondence to PD Dr. Robert Michael Hermann.

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A. Kaltenborn, E. Bulling, M. Nitsche, U.M. Carl, and R.M. Hermann state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Kaltenborn, A., Bulling, E., Nitsche, M. et al. The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis. Strahlenther Onkol 192, 582–588 (2016). https://doi.org/10.1007/s00066-016-0995-7

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Keywords

  • Rhizarthrosis
  • Carpometacarpal joints
  • Treatment outcome
  • Pain
  • Hand

Schlüsselwörter

  • Rhizarthrose
  • Karpometakarpalgelenke
  • Behandlungserfolg
  • Schmerz
  • Hand