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Radiotherapy for achillodynia

Results of a single-center prospective randomized dose-optimization trial

Strahlentherapie bei Achillodynie

Ergebnisse einer monoinstitutionalen, prospektiven und randomisierten Dosisoptimierungsstudie

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Abstract

Background and purpose

The aim of this study was to compare the efficacy of two different dose-fractionation schedules for radiotherapy of patients with achillodynia.

Patients and methods

Between February 2006 and February 2010, 112 consecutive evaluable patients were recruited for this prospective randomized trial. All patients underwent radiotherapy with an orthovoltage technique. One radiotherapy course consisted of 6 single fractions over 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 with a visual analogue scale (VAS) and a comprehensive pain score (CPS).

Results

The overall response rate for all patients was 84% directly after and 88% 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 55.7 ± 21.0 and 58.2 ± 23.5 (p = 0.526), 38.0 ± 23.2 and 30.4 ± 22.6 (p = 0.076), and 35.4 ± 25.9 and 30.9 ± 25.4 (p = 0.521), respectively. The mean CPS before, directly after, and 6 weeks after treatment was 8.2 ± 3.0 and 8.9 ± 3.3 (p = 0.239), 5.6 ± 3.1 and 5.4 ± 3.3 (p = 0.756), 4.4 ± 2.6 and 5.3 ± 3.8 (p = 0.577), respectively. No statistically significant differences were found between the two single-dose trial arms for early (p = 0.366) and delayed response (p = 0.287).

Conclusion

Radiotherapy is an effective treatment option for the management of achillodynia. For radiation protection, the dose of a radiotherapy series is recommended not to exceed 3–6 Gy.

Zusammenfassung

Hintergrund

Vergleich der Effektivität zweier Dosisfraktionierungskonzepte bei der Strahlentherapie von Patienten mit Achillodynie.

Patienten und Methode

Zwischen 2006 und 2010 wurden 112 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 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, nach sowie 6 Wochen nach der Strahlentherapie mit visueller Analogskala (VAS) und einem umfassenden Schmerzscore (CPS) gemessen.

Ergebnisse

Die Gesamtansprechrate aller Patienten betrug direkt nach Bestrahlung 84% und 6 Wochen danach 88%. Die mittleren VAS-Werte vor, direkt nach und 6 Wochen nach der Strahlentherapie waren für die 0,5- und 1,0-Gy-Gruppe 55,7 ± 21,0 und 58,2 ± 23,5 (p = 0,526), 38,0 ± 23,2 und 30,4 ± 22,6 (p = 0,076) sowie 35,4 ± 25,9 und 30,9 ± 25,4 (p = 0,521). Die mittleren Schmerzscore-Werte betrugen vor, direkt nach und 6 Wochen nach der Strahlentherapie 8,2 ± 3,0 und 8,9 ± 3,3 (p = 0,239), 5,6 ± 3,1 und 5,4 ± 3,3 (p = 0,756) sowie 4,4 ± 2,6 und 5,3 ± 3,8 (p = 0,577). Statistisch signifikante Unterschiede im Therapieansprechen (CPS) konnten zwischen den beiden Studienarmen nach (p = 0,366) und 6 Wochen nach Strahlentherapie (p = 0,287) nicht festgestellt werden.

Schlussfolgerung

Die Strahlentherapie ist eine effektive Maßnahme in der Behandlung der Achillodynie. 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, C. Jeremias, U.S. Gaipl, B. Frey, M. Schmidt & R. Fietkau

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  1. O.J. Ott
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  2. C. Jeremias
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  3. U.S. Gaipl
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  4. B. Frey
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  5. M. Schmidt
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  6. R. Fietkau
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Correspondence to O.J. Ott.

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Ott, O., Jeremias, C., Gaipl, U. et al. Radiotherapy for achillodynia. Strahlenther Onkol 189, 142–146 (2013). https://doi.org/10.1007/s00066-012-0240-y

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  • DOI: https://doi.org/10.1007/s00066-012-0240-y

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