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DEGRO guidelines for the radiotherapy of non-malignant disorders

Part II: Painful degenerative skeletal disorders

DEGRO-S2e-Leitlinie für die Strahlentherapie von gutartigen Erkrankungen

Teil II: Schmerzhafte degenerative Skeletterkrankungen

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Abstract

Background and purpose

The purpose of this article is to summarize the updated DEGRO consensus S2e guideline recommendations for the treatment of benign painful degenerative skeletal disorders with low-dose radiotherapy.

Materials and methods

This overview reports on the role of low-dose radiotherapy in the treatment of enthesiopathies (shoulder syndrome, trochanteric bursitis, plantar fasciitis, and elbow syndrome) and painful arthrosis (knee, hip, hand, and finger joints). The most relevant aspects of the DEGRO S2e Consensus Guideline Radiation Therapy of Benign Diseases 2014 regarding diagnostics, treatment decision, dose prescription as well as performance of radiotherapy and results are summarized.

Results

For all indications mentioned above, retrospective and some prospective analyses have shown remarkable effects in terms of pain relief. Nevertheless, the Level of Evidence (LoE) and the Grade of Recommendation (GR) vary: LoE 1b–4 and GR A–C.

Conclusion

Low-dose radiotherapy for painful degenerative skeletal disorders is effective in the majority of the patients and therefore it may be a reasonable therapeutic alternative when simple and non-invasive methods have been used without persistent success. For all discussed entities, single fraction doses of 0.5–1.0 Gy and total doses of 3.0–6.0 Gy/series applied with 2–3 fractions per week are recommended.

Zusammenfassung

Hintergrund

Zusammenfassung der Empfehlungen der DEGRO-S2e-Leitlinie zur Niedrigdosis-Radiotherapie von gutartigen schmerzhaften degenerativen Skeletterkrankungen.

Material und Methode

Die vorliegende Zusammenfassung berichtet über die Bedeutung der Niedrigdosis-Radiotherapie in der Behandlung von Enthesiopathien (Schultersyndrom, Ellenbogensyndrom, Bursitis trochanterica, Fasciitis plantaris) und schmerzhaften Arthrosen (Knie-, Hüft, Hand- und Fingergelenksarthrosen). Die wichtigsten Aspekte der aktuellen DEGRO-S2e-Konsensus-Leitlinie Strahlentherapie gutartiger Erkrankungen bezüglich Diagnostik, Therapieentscheidungen, Dosisempfehlungen und Durchführung einer Radiotherapie werden zusammengefasst.

Ergebnisse

Für alle genannten Entitäten wurde in zahlreichen retrospektiven und einigen prospektiven Untersuchungen ein bemerkenswerter Effekt der Niedrigdosis-Radiotherapie im Sinne einer Schmerzlinderung beschrieben. Je nach Entität wurden Evidenzlevel (LoE) von 1b–4 festgestellt, sodass unterschiedliche Empfehlungsgrade (GR) von A–C für den Einsatz der Radiotherapie ausgesprochen wurden.

Schlussfolgerung

Die Niedrigdosis-Radiotherapie von benignen schmerzhaften degenerativen Skeletterkrankungen ist bei der Mehrheit der Patienten effektiv im Sinne einer Schmerzlinderung und ist daher insbesondere für Patienten, bei denen andere konservative Verfahren ohne Einsatz ionisierender Strahlung zu keiner anhaltenden Verbesserung der Schmerzsymptomatik geführt haben, eine gut begründbare therapeutische Alternative. Empfohlen wird die Durchführung der Bestrahlung mit Fraktionsdosen von 0,5–1,0 Gy bis zu Gesamtdosen von 3,0–6,0 Gy/Bestrahlungsserie sowie 2–3 Fraktionen pro Woche.

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Compliance with ethical guidelines

Conflict of interest

Oliver J. Ott, Marcus Niewald, Hajo-Dirk Weitmann, Ingrid Jacob, Irenaeus A. Adamietz, Ulrich Schaefer, Ludwig Keilholz, Reinhard Heyd, and Ralph Muecke state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

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

    Oliver J. Ott

  2. Dept. of Radiotherapy and Radiation Oncology, Saarland University Medical School, Homburg/Saar, Germany

    Marcus Niewald

  3. Dept. of Radiooncology and Radiotherapy, Fulda Hospital, Fulda, Germany

    Hajo-Dirk Weitmann

  4. Dept. of Radiotherapy, Municipal Hospital Traunstein, Traunstein, Germany

    Ingrid Jacob

  5. Dept. of Radiotherapy and Radiation Oncology, Marien Hospital Herne/Ruhr University Bochum, Herne, Germany

    Irenaeus A. Adamietz & Ralph Muecke

  6. Dept. of Radiotherapy, Lippe Hospital, Lemgo, Germany

    Ulrich Schaefer & Ralph Muecke

  7. Dept. of Radiotherapy, Bayreuth Hospital, Bayreuth, Germany

    Ludwig Keilholz

  8. Center for Radiosurgery, Frankfurt a. M., Germany

    Reinhard Heyd

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  1. Oliver J. Ott
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  9. Ralph Muecke
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German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD)

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Correspondence to Oliver J. Ott.

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Ott, O., Niewald, M., Weitmann, HD. et al. DEGRO guidelines for the radiotherapy of non-malignant disorders. Strahlenther Onkol 191, 1–6 (2015). https://doi.org/10.1007/s00066-014-0757-3

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  • DOI: https://doi.org/10.1007/s00066-014-0757-3

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