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Álvarez B, Montero A, Alonso R, Valero J, López M, Ciérvide R, Sánchez E, Hernando O, García-Aranda M, Martí J, Prado A, Chen-Zhao X, Rubio C. Low-dose radiation therapy for hand osteoarthritis: shaking hands again? Clin Transl Oncol 2021; 24:532-539. [PMID: 34585316 DOI: 10.1007/s12094-021-02710-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hand osteoarthritis (HOA) is one of the most common causes of pain and functional disability in western countries and there is still no definitive cure. Low-dose radiation therapy (LDRT) has anti-inflammatory properties that have shown to be effective in the symptomatic relief of various degenerative musculoskeletal disorders. We designed a clinical protocol using LDRT for symptomatic HOA and present results and tolerance in the first 100 patients included. MATERIALS AND METHODS Between April 2015 and March 2021, 100 patients with a median age of 60 were treated. Fifty-seven patients suffering from proximal/distal interphalangeal joint pain, 40 patients with thumb arthritis, 2 patients with radiocarpal joint affection and 1 patient with metacarpophalangeal joint pain were enrolled. LDRT comprised of 6 fractions of 0.5-1 Gy on every other day up to a total dose of 3-6 Gy. Clinical response was evaluated according to the visual analog scale (VAS) for pain level and the von Pannewitz score (VPS) for joint functionality. Any patients not achieving subjective adequate pain relief after 8 weeks of treatment were offered a second identical LDRT course. RESULTS With a median follow-up of 10.5 months (range 7.55-12.45), 94% reported an improvement in the pain, with a significant reduction in the VAS level after 3, 6 and 12 months (p < 0.001). Sixty-three patients needed a second course of treatment at a median time interval of 12 weeks (range 9-14). The mean VAS score before treatment was 8 (range 3-10). After treatment, it was 5 (range 1-10). After 3, 6 and 12 months, the mean VAS scores were 4 (range 0-9), 3 (range 0-9) and 3.5 (range 0-9), respectively. Seventy patients reported functionality improvements after LDRT according to the von Pannewitz score. No acute or late complications were observed. CONCLUSION LDRT appears to be safe and useful for HOA and is associated with good rates of pain relief and functionality improvements. However, further studies are necessary to confirm these promising results.
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Affiliation(s)
- B Álvarez
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - A Montero
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain.
| | - R Alonso
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - J Valero
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - M López
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - R Ciérvide
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - E Sánchez
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - O Hernando
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - M García-Aranda
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - J Martí
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - A Prado
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - X Chen-Zhao
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - C Rubio
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
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Alvarez B, Montero A, Hernando O, Ciervide R, Garcia J, Lopez M, Garcia-Aranda M, Chen X, Flores I, Sanchez E, Valero J, Prado A, Alonso R, Alonso L, Fernandez-Leton P, Rubio C. Radiotherapy CT-based contouring atlas for non-malignant skeletal and soft tissue disorders: a practical proposal from Spanish experience. Br J Radiol 2021; 94:20200809. [PMID: 34282948 PMCID: PMC8764913 DOI: 10.1259/bjr.20200809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 05/26/2021] [Accepted: 06/08/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Interest in low-dose radiotherapy (LD-RT) for the symptomatic treatment of nonmalignant conditions, including inflammatory and degenerative disorders of the joints and para-articular soft tissues, has increased substantially in recent years. In the present document, we provide a CT-based contouring atlas to help identify and delineate the most common osteoarticular regions susceptible to LD-RT. METHODS The clinical efficacy of LD-RT is supported by a large body of evidence. However, there is no consensus on the parameters for contouring the planning target volume (PTV). Moreover, 3D simulation and planning should be the standard of care even for nonmalignant disorders. For this reason, the present guidelines were prepared to help guide PTV contouring based on CT images, with the same quality criteria for patient immobilization, treatment simulation, planning and delivery as those routinely applied for cancer radiotherapy. RESULTS PTV for radiotherapy requires precise identification of the target areas based on CT and other imaging techniques. Using a series of cases treated at our institution, we have defined the PTVs for each location on the simulation CT to establish the relationship between the image and the anatomical structures to be treated. We also specify the immobilization systems used to ensure treatment accuracy and reproducibility. CONCLUSIONS This comprehensive atlas based on CT images may be of value to radiation oncologists who wish to use LD-RT for the symptomatic treatment of degenerative or inflammatory osteoarticular diseases. ADVANCES IN KNOWLEDGE The recommendations and contouring atlas described in this article provide an eminently practical tool for LD-RT in non-malignant conditions, based on the same quality criteria recommended for all modern radiotherapy treatments in Spain.
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Affiliation(s)
- Beatriz Alvarez
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Angel Montero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Ovidio Hernando
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Raquel Ciervide
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Juan Garcia
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - Mercedes Lopez
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | | | - Xin Chen
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Ines Flores
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - Emilio Sanchez
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | | | | | - Rosa Alonso
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Leyre Alonso
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | | | - Carmen Rubio
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
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Álvarez B, Montero Á, Aramburu F, Calvo E, Ángel de la Casa M, Valero J, Hernando O, López M, Ciérvide R, García-Aranda M, Rodríguez S, Sánchez E, Chen X, Alonso R, García de la Peña P, Rubio C. Radiotherapy for ostheoarticular degenerative disorders: When nothing else works. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 1:100016. [DOI: 10.1016/j.ocarto.2019.100016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/27/2019] [Indexed: 01/05/2023] Open
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