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Radiotherapy for benign calcaneodynia

Long-term results of the Erlangen Dose Optimization (EDO) trial

Strahlentherapie bei Calcaneodynie

Langzeitergebnisse der Erlanger Dosisoptimierungsstudie (EDO)

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Abstract

Background and purpose

The goal of this work was to evaluate the long-term efficacy of two dose-fractionation schedules for radiotherapy of calcaneodynia.

Patients and methods

Between February 2006 and February 2010, 457 evaluable patients were recruited for this prospective trial. All patients received orthovoltage radiotherapy. One course consisted of 6 fractions/3 weeks. In case of insufficient remission of pain after 6 weeks a second series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before, right after (early response), 6 weeks (delayed response), and approximately 2.5 years after radiotherapy (long-term response) with a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS).

Results

The median follow-up was 32 months (range 9–57 months). The overall early, delayed, and long-term response rates for all patients were 87, 88, and 95 %. The mean VAS values before treatment, for early, delayed, and long-term response for the 0.5 and 1.0 Gy groups were 65.5 ± 22.1 and 64.0 ± 20.5 (p = 0.19), 34.8 ± 24.7 and 39.0 ± 26.3 (p = 0.12), 25.1 ± 26.8 and 28.9 ± 26.8 (p = 0.16), and 16.3 ± 24.3 and 14.1 ± 19.7 (p = 0.68). The mean CPS values before treatment, for early, delayed, and log-term response were 10.1 ± 2.7 and 10.0 ± 3.0 (p = 0.78), 5.6 ± 3.7 and 6.0 ± 3.9 (p = 0.34), 4.0 ± 4.1 and 4.3 ± 3.6 (p = 0.26), and 2.1 ± 3.3 and 2.3 ± 3.2 (p = 0.34), respectively. No significant differences in long-term response quality between the two arms were found (p = 0.50).

Conclusion

Radiotherapy is a very effective treatment for the management of benign calcaneodynia. For radiation protection reasons, the dose for a RT series should not exceed 3.0 Gy.

Zusammenfassung

Hintergrund und Ziel

Untersuchung der Langzeiteffektivität zweier Dosisfraktionierungskonzepte bei der Strahlentherapie von Patienten mit Calcaneodynie.

Patienten und Methoden

Zwischen 2006 und 2010 wurden 457 auswertbare Patienten in diese prospektive und randomisierte Phase-IV-Studie eingeschlossen. Alle Patienten erhielten die Bestrahlung in Orthovolt-Technik. Eine Bestrahlungsserie bestand aus 6 Fraktionen/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, unmittelbar nach ("early response"), 6 Wochen nach ("delayed response") sowie etwa 2,5 Jahre nach der Strahlentherapie ("long-term response") mittels visueller Analogskala (VAS) und einem umfassenden Schmerzscore (CPS) gemessen.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 32 Monate (Spanne 9–57 Monate). Die Raten für das frühe, verzögerte und Langzeitansprechen aller Patienten betrugen 87, 88 und 95 %. Die mittleren VAS-Werte vor Behandlung, für das frühe, verzögerte und Langzeitansprechen waren für die 0,5- und 1,0-Gy-Gruppe 65,5 ± 22,1 und 64,0 ± 20,5 (p = 0,19), 34,8 ± 24,7 und 39,0 ± 26,3 (p = 0,12), 25,1 ± 26,8 und 28,9 ± 26,8 (p = 0,16) sowie 16,3 ± 24,3 und 14,1 ± 19,7 (p = 0,68). Die entsprechenden mittleren CPS-Werte betrugen 10,1 ± 2,7 und 10,0 ± 3,0 (p = 0,78), 5,6 ± 3,7 und 6,0 ± 3,9 (p = 0,34), 4,0 ± 4,1 und 4,3 ± 3,6 (p = 0,26) sowie 2,1 ± 3,3 und 2,3 ± 3,2 (p = 0,34). Zwischen den beiden Studienarmen konnten keinerlei statistisch signifikante Unterschiede in der Qualität des Langzeitansprechens festgestellt werden (p = 0,50).

Schlussfolgerung

Die Strahlentherapie ist langfristig eine sehr effektive Maßnahme zur Behandlung der Calcaneodynie. Aus Strahlenschutzgründen sollte eine Gesamtdosis von 3 Gy pro Bestrahlungsserie nicht überschritten werden.

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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).

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Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Dept. of Radiation Oncology, University Hospital Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany

    Oliver J. Ott, Carolin Jeremias, Udo S. Gaipl, Benjamin Frey, Manfred Schmidt & Rainer Fietkau

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  1. Oliver J. Ott
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Correspondence to Oliver J. Ott.

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Ott, O., Jeremias, C., Gaipl, U. et al. Radiotherapy for benign calcaneodynia. Strahlenther Onkol 190, 671–675 (2014). https://doi.org/10.1007/s00066-014-0618-0

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