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Low-dose external beam radiotherapy for greater trochanteric pain syndrome

Target volume definition and treatment outcome

Niedrig dosierte Reizbestrahlung beim Trochanter-major-Schmerzsyndrom

Zielvolumendefinition und Therapieergebnisse

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Abstract

Purpose

Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives.

Patients and methods

In all, 60 patients (74 hips) received LD-EBRT (6 × 0.5 Gy in 29 hips, 6 × 1 Gy in 45). The endpoint was the patient’s reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated.

Results

At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis “inclusion of the total femoral head into the PTV” and “night pain before LD-EBRT” were correlated with symptom remission at the end of LD-EBRT, while “initial increase in pain during LD-EBRT” was significantly associated with treatment failure. In multivariable modeling “initial increase in pain” was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048–0.957), while “night pain” was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004–12.6). Three months after LD-EBRT “night pain” and “inclusion of the complete femoral neck circumference into the PTV” were predictive for remission.

Conclusion

LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed.

Zusammenfassung

Hintergrund

In der Behandlung des therapierefraktären Trochanter-major-Schmerzsyndroms (GTPS) spielt die niedrig dosierte „Reizbestrahlung“ (LD-EBRT) eine wichtige Rolle, obwohl nur wenige Studien dazu vorliegen. Deshalb analysierten wir retrospektiv die Therapieergebnisse in unseren Kollektiven.

Patienten und Methoden

Insgesamt 60 Patienten (74 Hüften) erhielten eine Reizbestrahlung (6 × 0,5 Gy bei 29 Hüften, 6 × 1 Gy bei 45). Endpunkt war das subjektive Therapieansprechen. Verschiedene potentielle Einflussfaktoren auf das Therapieansprechen wurden untersucht.

Ergebnisse

Bei Abschluss der LD-EBRT berichteten 69% eine partielle Remission, 4% eine vollständige Remission und 28% keine Veränderung. Nach 3 Monaten (n = 52) waren es 37, 33 und 30 %, nach 18 Monaten (n = 47) 21, 51 und 28%. In der univariaten Analyse waren „Einschluss des Femurkopfs in das Zielvolumen“ und „Nachtschmerz vor LD-EBRT“ signifikant mit einem Ansprechen bei Abschluss der LD-EBRT korreliert, „initiale Schmerzverstärkung unter LD-EBRT“ hingegen mit einem Therapieversagen. In der multivariablen Analyse wurden „initiale Schmerzverstärkung“ als Risikofaktor (p = 0,007; Odds Ratio [OR] 0,209; 95%-Konfidenzintervall [KI] 0,048–0,957) und „Nachtschmerz“ als unabhängiger positive prädiktiver Faktor (p = 0,038; OR 3,484; 95%-KI 1,004–12,6) identifiziert. „Nachtschmerz“ und „Einschluss des gesamten Femurhalsumfangs in das Zielvolumen“ waren 3 Monate nach LD-EBRT mit einer Remission korreliert.

Schlussfolgerung

LD-EBRT ist eine wichtige Therapieoption für Patienten mit GTPS. Drei Monate nach Therapie berichten zwei Drittel der Patienten eine partielle oder vollständige Remission. Besonders profitieren Patienten, die zuvor unter nächtlichen Schmerzen gelitten hatten. Der Therapieerfolg schien abhängig zu sein vom Einschluss der gesamten Zirkumferenz des Femurhalses in das Zielvolumen.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany

    Alexander Kaltenborn MD

  2. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany

    Alexander Kaltenborn MD

  3. Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede, Germany

    Ulrich Martin Carl MD, Tanja Hinsche MD, Mirko Nitsche MD &  Robert Michael Hermann MD

  4. Department of Radiotherapy, Karl-Lennert Cancer Center, University of Schleswig Holstein, Campus Kiel, Kiel, Germany

    Mirko Nitsche MD

  5. Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany

    Robert Michael Hermann MD

Authors
  1. Alexander Kaltenborn MD
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  2. Ulrich Martin Carl MD
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  3. Tanja Hinsche MD
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  4. Mirko Nitsche MD
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  5. Robert Michael Hermann MD
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Corresponding author

Correspondence to Robert Michael Hermann MD.

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Conflict of interest

A. Kaltenborn, U.M. Carl, T. Hinsche, M. Nitsche and R.M. Hermann declare that they have no competing interest.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Kaltenborn, A., Carl, U.M., Hinsche, T. et al. Low-dose external beam radiotherapy for greater trochanteric pain syndrome. Strahlenther Onkol 193, 260–268 (2017). https://doi.org/10.1007/s00066-016-1071-z

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  • DOI: https://doi.org/10.1007/s00066-016-1071-z

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