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Benign painful shoulder syndrome

Initial results of a single-center prospective randomized radiotherapy dose-optimization trial

Strahlentherapie bei Schultersyndrom

Ergebnisse einer monoinstitutionalen, prospektiven und randomisierten Dosisoptimierungsstudie

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Abstract

Background and purpose

To compare the efficacy of two different dose-fractionation schedules for radiotherapy of patients with benign painful shoulder syndrome.

Patients and methods

Between February 2006 and February 2010, 312 consecutive evaluable patients were recruited for this prospective randomized trial. All patients received radiotherapy with an orthovoltage technique. One radiotherapy course consisted of 6 single fractions in 3 weeks. In case of insufficient remission of pain after 6 weeks, a second radiation series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. The endpoint was pain reduction. Pain was measured before, right after, and 6 weeks after radiotherapy using a visual analogue scale (VAS) and a comprehensive pain score (CPS).

Results

The overall response rate for all patients was 83% directly after and 85% 6 weeks after radiotherapy. The mean VAS values before, directly after, and 6 weeks after treatment for the 0.5 and 1.0 Gy groups were 56.8 ± 23.7 and 53.2 ± 21.8 (p = 0.158), 38.2 ± 26.1 and 34.0 ± 24.5 (p = 0.189), and 33.0 ± 27.2 and 23.7 ± 22.7 (p = 0.044), respectively. The mean CPS before, directly after, and 6 weeks after treatment was 9.7 ± 3.0 and 9.5 ± 2.7 (p = 0.309), 6.1 ± 3.6 and 5.4 ± 3.6 (p = 0.096), 5.3 ± 3.7 and 4.1 ± 3.7 (p = 0.052), respectively. Despite a slight advantage in the VAS analysis for the 1.0 Gy group for delayed response, the CPS analysis revealed no statistically significant differences between the two single-dose trial arms for early (p = 0.652) and delayed response quality (p = 0.380).

Conclusion

Radiotherapy is an effective treatment option for the management of benign painful shoulder syndrome. Concerning radiation protection, the dose for a radiotherapy series is recommended not to exceed 3–6 Gy.

Zusammenfassung

Hintergrund

Vergleich der Effektivität zweier Dosisfraktionierungskonzepte bei der Strahlentherapie von Patienten mit schmerzhaftem Schultersyndrom.

Material und Methode

Zwischen 2006 und 2010 wurden 312 auswertbare Fälle in diese prospektive und randomisierte Studie eingeschlossen. Alle Patienten erhielten die Bestrahlung in Orthovolt-Technik. Eine Bestrahlungsserie bestand aus 6 Einzelfraktionen/3 Wochen. Bei ungenügendem Ansprechen der Schmerzsymptomatik nach 6 Wochen wurde eine zweite Bestrahlungsserie durchgeführt. Die Patienten wurden auf die beiden Studienarme randomisiert verteilt und erhielten je nach Ergebnis Einzeldosen von 0,5 bzw. 1,0 Gy. Der Endpunkt der vorliegenden Analyse war die Schmerzreduktion. Die Schmerzintensität wurde vor, direkt nach sowie 6 Wochen nach der Strahlentherapie mittels visueller Analogskala (VAS) und eines umfassenden Schmerzscores (CPS) gemessen.

Ergebnisse

Die Gesamtansprechrate aller Patienten betrug 83% direkt nach und 85% 6 Wochen nach Bestrahlung. Die mittleren VAS-Werte vor, direkt nach und 6 Wochen nach der Strahlentherapie betrugen für die 0,5- und 1,0-Gy-Gruppe 56,8 ± 23,7 bzw. 53,2 ± 21,8 (p = 0,158); 38,2 ± 26,1 bzw. 34,0 ± 24,5 (p = 0,189) sowie 33,0 ± 27,2 bzw. 23,7 ± 22,7 (p = 0,044). Die mittleren Schmerzscore-Werte betrugen vor, nach und 6 Wochen nach der Strahlentherapie 9,7 ± 3,0 bzw. 9,5 ± 2,7 (p = 0,309); 6,1 ± 3,6 bzw. 5,4 ± 3,6 (p = 0,096); 5,3 ± 3,7 bzw. 4,1 ± 3,7 (p = 0,052). Trotz eines kleinen Vorteils in der VAS-Analyse beim verzögerten Ansprechen für die 1,0-Gy-Gruppe wurden bei der CPS-Analyse keine statistisch signifikanten Unterschiede im qualitativen Therapieansprechen zwischen den beiden Studienarmen direkt nach (p = 0,652) und 6 Wochen nach Strahlentherapie (p = 0,380) festgestellt.

Schlussfolgerung

Die Strahlentherapie ist eine effektive Maßnahme in der Behandlung des schmerzhaften Schultersyndroms. Aus Strahlenschutzgründen wird empfohlen, eine Gesamtdosis von 3–6 Gy pro Bestrahlungsserie nicht zu überschreiten.

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Acknowledgments

This work was supported in part by the German Federal Ministry of Education and Research (GREWIS, 02NUK017G) and the European Commission (DoReMi, European Network of Excellence, contract number 249689).

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Erlangen, Universitätsstr. 27, 91054, Erlangen, Germany

    O.J. Ott, S. Hertel, U.S. Gaipl, B. Frey, M. Schmidt & R. Fietkau

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  1. O.J. Ott
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  2. S. Hertel
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  3. U.S. Gaipl
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  4. B. Frey
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Correspondence to O.J. Ott.

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Ott, O., Hertel, S., Gaipl, U. et al. Benign painful shoulder syndrome. Strahlenther Onkol 188, 1108–1113 (2012). https://doi.org/10.1007/s00066-012-0237-6

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