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Analgesic effects of low-dose radiotherapy in greater trochanteric pain syndrome: results in a clinical series of 155 patients with recurrent or refractory symptoms

Clinical and Translational Oncology volume 24, pages 846–853 (2022)Cite this article

Abstract

Purpose

This prospective study assessed the effects of low-dose radiotherapy in patients diagnosed with greater trochanteric pain syndrome (GTPS) with recurrent symptoms or refractory to previous conservative measures.

Methods

We evaluated a total of 155 patients (90.3% women, mean age 69 years). Most patients (n = 136) received 10 Gy (1 Gy/day/3 fractions per week on alternate days), but after recommendations of DEGRO guidelines published in 2015, the remaining 19 patients (12.2%) received 6 Gy (1 Gy/day/3 fractions per week on alternate days).

Results

At the pre-treatment visit, the mean (standard deviation, SD) visual analog scale (VAS) score was 8), which decreased to 5 (SD 2.2) after 1 month of the end of treatment and to 4 (SD 2.3) after 4 months. An objective symptom response with increased mobility, better sleep quality, and reduction of analgesic medication was found in 56% of patients at 1 month. In 129 patients (83.2%), there was a decrease of at least 1 point in the VAS score, and in 49 patients (29.0%), the VAS score was lower than 3. The mean length of follow-up was 45 months. The probability of maintaining the analgesic response estimated by the Kaplan-Meier method was 53% at 5 years.

Conclusion

Low dose radiotherapy effectively improved pain in the trochanteric area in most patients with recurrent or refractory GTPS, allowing a reduction in the need for analgesic medications and, more, importantly, better functioning and mobility. Further randomized studies in selected populations of GTPS are needed to define the treatment position of low-dose radiotherapy in this clinical setting.

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References

  1. Segal NA, Felson DT, Torner JC, et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88:988–92.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Speers CJB, Bhogal GS. Greater trochanteric pain syndrome: a review of diagnosis and management in general practice. Br J Gen Pract. 2017;67:479–80.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fearon AM, Cook JL, Scarvell JM, Neeman T, et al. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplasty. 2014;29:383–6.

    Article  PubMed  Google Scholar 

  4. Kingzett-Taylor A, Tirman PF, Feller J, et al. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR Am J Roentgenol. 1999;173:1123–6.

    Article  CAS  PubMed  Google Scholar 

  5. Ali M, Oderuth E, Atchia I, Malviya A. The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review. J Hip Preserv Surg. 2018;5:209–19.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011;21:447–53.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Torres A, Fernández-Fairen M, Sueiro-Fernández J. Greater trochanteric pain syndrome and gluteus medius and minimus tendinosis: nonsurgical treatment. Pain Manag. 2018;8:45–55.

    Article  PubMed  Google Scholar 

  8. Ott OJ, Niewald M, Weitmann HD, et al. German cooperative group on radiotherapy for benign diseases (GCG-BD). DEGRO guidelines for the radiotherapy of non-malignant disorders. Part II: painful degenerative skeletal disorders. Strahlenther Onkol. 2015;191:1–6.

    Article  PubMed  Google Scholar 

  9. Kern PM, Keilholz L, Forster C, Hallmann R, et al. Low-dose radiotherapy selectively reduces adhesion of peripheral blood mononuclear cells to endothelium in vitro. Radiother Oncol. 2000;54:273–82.

    Article  CAS  PubMed  Google Scholar 

  10. Arenas M, Sabater S, Hernández V, et al. Anti-inflammatory effects of low-dose radiotherapy. Indications, dose, and radiobiological mechanisms involved. Strahlenther Onkol. 2012;188:975–81.

    Article  CAS  PubMed  Google Scholar 

  11. Mollà M, Panés J, Casadevall M, Anderson DC, Granger DN, Piqué JM. Influence of dose-rate on inflammatory damage and adhesion molecule expression after abdominal radiation in the rat. Int J Radiat Oncol Biol Phys. 1999;45:1011–8.

    Article  PubMed  Google Scholar 

  12. Trott KR, Kamprad F. Radiobiological mechanisms of anti-inflammatory radiotherapy. Radiother Oncol. 1999;51:197–203.

    Article  CAS  PubMed  Google Scholar 

  13. Rödel F, Keilholz L, Herrmann M, et al. Radiobiological mechanisms in inflammatory diseases of low-dose radiation therapy. Int J Radiat Biol. 2007;83:357–66.

    Article  PubMed  Google Scholar 

  14. Donaubauer AJ, Deloch L, Becker I, et al. The influence of radiation on bone and bone cells-differential effects on osteoclasts and osteoblasts. Int J Mol Sci. 2020;21:6377.

    Article  CAS  PubMed Central  Google Scholar 

  15. Kaltenborn A, Carl UM, Hinsche T, et al. Low-dose external beam radiotherapy for greater trochanteric pain syndrome: target volume definition and treatment outcome. Strahlenther Onkol. 2017;193:260–8.

    Article  PubMed  Google Scholar 

  16. Biete A, Valduvieco I, Arenas M, Holub K. Low-dose radiotherapy as an effective treatment of trochanteric bursitis in elderly patients. Ann Radiat Ther Oncol. 2017;1:1003.

    Google Scholar 

  17. Valduvieco I, Biete A, Moreno LA, et al. Is anti-inflammatory radiotherapy an effective treatment in trochanteritis? Br J Radiol. 2017;90:20160520.

    Article  PubMed  Google Scholar 

  18. Seegenschmiedt MH, Micke O, Muecke R. German cooperative group on radiotherapy for non-malignant diseases (GCG-BD). Radiotherapy for non-malignant disorders: state of the art and update of the evidence-based practice guidelines. Br J Radiol. 2015;88:e20150080.

    Article  Google Scholar 

  19. Álvarez B, Montero A, Aramburu F, et al. Radiotherapy for osteoarticular degenerative disorders: when nothing else works. Osteoarthr Cartil Open. 2020;1:e100016.

    Article  Google Scholar 

  20. Micke O, Seegenschmiedt MH, Adamietz IA, et al. German cooperative group on radiotherapy for nonmalignant diseases (GCG-BD). Low-dose radiation therapy for benign painful skeletal disorders: the typical treatment for the elderly patient? Int J Radiat Oncol Biol Phys. 2017;98:953–8.

    Google Scholar 

  21. Juniku N, Micke O, Seegenschmiedt MH, Muecke R. Radiotherapy for painful benign skeletal disorders: results of a retrospective clinical quality assessment. Strahlenther Onkol. 2019;195:1068–73.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Goldie I, Rosengren B, Moberg E, Hedelin E. Evaluation of radiation treatment of painful conditions of the locomotor system. A double blind study. Acta Radiol Ther Phys Biol. 1970;9:311–22.

    Article  CAS  PubMed  Google Scholar 

  23. Minten MJM, Leseman-Hoogenboom MM, Kloppenburg M, et al. Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis Cartilage. 2018;26:1283–90.

    Article  CAS  PubMed  Google Scholar 

  24. Mahler EAM, Minten MJ, Leseman-Hoogenboom MM, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. Ann Rheum Dis. 2019;78:83–90.

    Article  CAS  PubMed  Google Scholar 

  25. Ott OJ, Micke O, Mücke R, et al. German cooperative group on radiotherapy for benign diseases (GCG-BD). Low-dose radiotherapy: mayday, mayday. We’ve been hit! Strahlenther Onkol. 2019;195:285–8.

    Article  PubMed  Google Scholar 

  26. Schröder S, Kriesen S, Paape D, et al. Modulation of inflammatory reactions by low-dose ionizing radiation: cytokine release of murine endothelial cells is dependent on culture conditions. J Immunol Res. 2018;2018(3):2856518.

    PubMed  PubMed Central  Google Scholar 

  27. Sautter-Bihl ML, Liebermeister E, Scheurig H, Heinze HG. Analgesic irradiation of degenerative-inflammatory skeletal diseases. Benefits and risks Dtsch Med Wochenschr. 1993;118:493–8.

    Article  CAS  PubMed  Google Scholar 

  28. Jansen JT, Broerse JJ, Zoetelief J, Klein C, Seegenschmiedt HM. Estimation of the carcinogenic risk of radiotherapy of benign diseases from shoulder to heel. Radiother Oncol. 2005;76:270–7.

    Article  PubMed  Google Scholar 

  29. Cuttler JM. Application of low doses of ionizing radiation in medical therapies. Dose Response. 2020;18:1559325819895739.

    PubMed  PubMed Central  Google Scholar 

  30. Donaubauer AJ, Zhou JG, Ott OJ, et al. Low dose radiation therapy, particularly with 0.5 Gy, improves pain in degenerative joint disease of the fingers: results of a retrospective analysis. Int J Mol Sci. 2020;21:e5854.

    Article  PubMed  Google Scholar 

  31. Calabrese EJ, Dhawan G, Kapoor R, Kozumbo WJ. Radiotherapy treatment of human inflammatory diseases and conditions: Optimal dose. Hum Exp Toxicol. 2019;38:888–98.

    Article  CAS  PubMed  Google Scholar 

  32. Kriz J, Seegenschmiedt HM, Bartels A, et al. Updated strategies in the treatment of benign diseases-a patterns of care study of the German cooperative group on benign diseases. Adv Radiat Oncol. 2018;3:240–4.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank Marta Pulido, MD, PhD, for editing the manuscript and editorial assistance, and Ms. Lourdes Barragán for help in the collection of data.

Funding

This research received no external funding.

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Authors and Affiliations

  1. Radiation Oncology Department, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain

    Albert Biete

  2. Radiation Oncology Department, Hospital Clínic, Barcelona, Spain

    Izaskun Valduvieco, Carla Cases, Ángeles Rovirosa, Gabriela Oses, Joel Mases & Meritxell Mollà

  3. Orthopaedic Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Jenaro Fernández-Valencia

  4. Anesthesiology Department, Pain Clinic, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Luis Alfonso Moreno

  5. Radiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Montserrat del Amo

Authors
  1. Albert Biete
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  2. Izaskun Valduvieco
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  7. Ángeles Rovirosa
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Correspondence to Izaskun Valduvieco.

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Institutional review board statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Hospital Clínic of Barcelona, Spain.

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Informed consent was obtained from all subjects involved in the study.

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Biete, A., Valduvieco, I., Cases, C. et al. Analgesic effects of low-dose radiotherapy in greater trochanteric pain syndrome: results in a clinical series of 155 patients with recurrent or refractory symptoms. Clin Transl Oncol 24, 846–853 (2022). https://doi.org/10.1007/s12094-021-02730-6

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Keywords

  • Low-dose radiotherapy
  • Greater trochanteric pain syndrome
  • Lateral hip pain
  • Non-cancer diseases radiation