Low-dose radiotherapy for painful osteoarthritis of the elderly: A multicenter analysis of 970 patients with 1185 treated sites

Modulating systemic anti-inflammatory response mitigates osteoarthritis progression and associated pain after low-dose radiotherapy

Osteoarthritis (OA) is a degenerative joint disease, often accompanied by inflammation. It has reported that low-dose radiotherapy (LDRT) has anti-inflammatory effect for benign pathologies and has been used for clinical treatment of OA in some European regions. However, the underlying molecular mechanisms of LDRT alleviating OA are only poorly understood. Herein, it is verified that LDRT improved the locomotor ability of OA rats, increased the locomotor distance and speed in the in vivo experiments. Moreover, LDRT decreased the degree of cartilage damage, attenuated the synovial inflammation, and promoted macrophage polarization towards M2 type. For the in vitro experiments, LDRT promoted macrophage polarization towards M2-type, which enhanced cell growth and adjusted the inflammatory factors in chondrocyte. Additionally, it is found LDRT could ameliorate OA pain through inhibiting spinal cord inflammation. Take together, our study suggests that LDRT could ameliorate OA symptoms and relieve OA-related pain by exerting its anti-inflammatory effect.

Comparative effectiveness of kilo- and megavoltage energies in low-dose radiotherapy for painful degenerative musculoskeletal diseases: a systematic review and meta-analysis

PURPOSE

This study aimed to assess the impact of different energy levels on the effectiveness of low-dose radiotherapy (LDRT) for treating painful degenerative musculoskeletal diseases, as comparative efficacy data are currently lacking.

METHODS

A systematic review was conducted in PubMed, Embase, and the Cochrane Library databases to identify studies with response information on the energy used (kilovoltage [kV] vs. megavoltage [MV]). The primary endpoint was the overall response rate (ORR), and the secondary endpoint was the complete response rate (CRR). Exploratory subgroup analyses included treatment site, study period, study design, country, and dose per fraction.

RESULTS

A total of 33 studies involving 12,143 patients were analyzed. Short-term follow-up (up to 6 months) showed a pooled ORR of 64% (95% CI 46-78%) for kV and of 62% (95% CI 54-70%) for MV. Long-term follow-up (at least 12 months) revealed a pooled ORR of 85% (95% CI 65-95%) for kV and of 69% (95% CI 62-75%) for MV. Subgroup analysis indicated no significant differences in ORR for energy level stratified by treatment site and other factors. Regarding dose per fraction (0.5 Gy vs. 1.0 Gy), comparable ORRs were demonstrated between the two energies. No clinical side effects were noted.

CONCLUSION

This meta-analysis suggests that the known effectiveness of LDRT in painful degenerative musculoskeletal disease may not depend on the energy used. Additional studies using standardized evaluation methods are warranted to establish consistency and enhance the comprehensiveness of research. Further research is also needed to explore treatment modality selection considering disease-specific biology.

Effects of low dose rate radiotherapy on pain relief, performance score, and quality of life in patients with knee osteoarthritis; a double-blind sham-controlled randomized clinical trial

INTRODUCTION

Knee osteoarthritis (OA) is a prevalent chronic condition characterized by progressive damage to the articular cartilage, resulting in chronic pain, swelling, and reduced range of motion with a range of prevalence of 10-40%. This study aims to investigate the efficacy of low-dose radiation as a local treatment option for knee OA symptoms.

METHODS

In this prospective study, patients with confirmed OA and older than 65 years were randomly assigned to treatment and control groups. The protocol plan IRCT20160706028815N6 was registered in Iranian registry of clinical trials system. The treatment group received 3 Gy radiation over six fractions, while the control group continued routine treatment without radiation. The pain intensity and functional levels were assessed at pretreatment and each month following completion of therapy for six consecutive months by Visual Analog Scale (VAS) and the Lysholm 100-point Scale, respectively. Analgesic medication usage and performance status (PS) were also assessed.

RESULTS

The mean age of the patients was 77 years (range 72-89). All variables including VAS pain score, Lysholm scale, PS and analgesic consumption were improved following radiation from first month to the end of assessments (p value <0.01).

CONCLUSION

Results showed significant pain score improvements and enhanced joint function with no adverse effects. Findings were compared with previous studies, revealing mixed conclusions on low dose radiation therapy (LDRT) efficacy. Mechanistic hypotheses suggest LDRT may modulate inflammatory pathways. The study suggests LDRT at 3 Gy could benefit knee osteoarthritis patients and calls for further research on mechanisms of action in early-stage osteoarthritis.

Low-dose Radiation Therapy (LDRT) in Managing Osteoarthritis: A Comprehensive Review

Osteoarthritis (OA) is the most common degenerative arthropathy, impacting the quality of life for millions worldwide. It typically presents with chronic pain, stiffness, and reduced mobility in the affected joints. Nonsurgical treatments like physiotherapy or pharmacotherapy may provide limited relief and may have adverse effects and complications. Recently, low-dose radiation therapy (LDRT) has emerged as a potential alternative for managing OA, utilizing its anti-inflammatory effects. LDRT's anti-inflammatory effects involve modulating immune responses, reducing pro-inflammatory cytokines, and inducing apoptosis in inflammatory cells. Clinical studies show varying degrees of symptom relief, with some patients experiencing pain reduction and improved joint mobility while others show minimal response. The variability in LDRT treatment designs, radiation dosages, and patient populations complicates standardized treatment protocols and raises concerns about potential carcinogenic risks. Despite these issues, LDRT shows promise as an alternative to other OA treatments, especially for patients who don't respond to other treatments. This review aims to provide updated information on the effectiveness, mechanisms, and safety of LDRT in treating OA. We reviewed the literature of studies on the safety and efficacy of LDRT on affected joints by OA, its biological effects, potential therapeutic and adverse effects, application and contraindications, clinical outcomes, and clinical evidence in subjects with OA.

Radiation Therapy for the Treatment of Osteoarthritis

Osteoarthritis is a common cause of pain and disability in the United States. Many patients experience pain that is refractory or unable to be treated by traditional treatments such as exercise, physical therapy, nonsteroidal anti-inflammatory drugs, and/or cyclooxygenase-2 inhibitors. For patients with medically refractory disease, intra-articular corticosteroid therapy, hyaluronic acid, or surgery can be considered. However, for many older patients with significant impairment in quality of life related to osteoarthritis, radiation therapy is a noninvasive treatment option that has a long history of global use. In this topic discussion, we review the clinical evidence supporting treatment of osteoarthritis, as well as considerations for how to select which patient and joint to treat. We discuss technical considerations for treatment including dose and immobilization, assessment of treatment response, and the role of retreatment.

Low-dose radiotherapy for greater trochanteric pain syndrome-a single-centre analysis

PURPOSE

To determine predictive factors associated with a good response (GR) to and efficacy of low-dose radiotherapy (LDRT) in patients with greater trochanteric pain syndrome (GTPS).

METHODS

Patients with GTPS were irradiated on a linear accelerator with 0.5-1.0 Gy per fraction to a total dose of 3.0-4.0 Gy per series. The endpoint was subjective good response (GR) to treatment 2 months after completion of the last LDRT series, defined as complete pain relief or marked improvement assessed using the von Pannewitz score. A positive response to steroid injection (SI) was defined as pain relief of at least 7 days. Patient and treatment-related characteristics were evaluated with respect to LDRT outcomes.

RESULTS

Outcomes were assessed for 71 peritrochanteric spaces (PTSs; 65 patients, 48 females, with mean age of 63 [44-91] years). Prior SI had been given to 55 (77%) PTSs and 40 PTSs received two series of LDRT. Two months after completion of LDRT, GR was reported in 42 PTSs (59%). Two series of LDRT provided a significantly higher rate of GR than one series (72.5 vs. 42% PTSs, p = 0.015). Temporary pain relief after prior SI predicted GR to LDRT compared with PTSs which had not responded to SI (73 vs. 28% PTSs, p = 0.001). A regional structural abnormality, present in 34 PTSs (48%), was associated with a reduction of GR to LDRT (44 vs. 73% PTSs, p = 0.017).

CONCLUSION

LDRT is an effective treatment for GTPS. Administration of two LDRT series, prior response to SI, and absence of structural abnormalities may predict significantly better treatment outcomes.

An introduction to low dose radiation therapy for shoulder osteoarthritis

Osteoarthritis (OA) is a painful, degenerative disease that affects the tissues of the joint spaces, such as the shoulder. Conventional medical treatment options, such as corticosteroid injections and anti-inflammatory medications, are not always sufficient to alleviate the symptoms from this disease. Low dose radiotherapy is a newer treatment option for patients with shoulder osteoarthritis and has shown positive outcomes. However, the problem is that there is a paucity of literature about treatment planning considerations for this new treatment option. The purpose of this case study was to provide an example of treatment planning techniques and considerations for shoulder osteoarthritis. Treatment techniques for shoulder LDRT, such as treatment field borders, prescribed dose, beam arrangements, appropriate beam energy, and special considerations are discussed.

Low-dose radiotherapy of osteoarthritis: from biological findings to clinical effects-challenges for future studies

Osteoarthritis (OA) is one of the most common and socioeconomically relevant diseases, with rising incidence and prevalence especially with regard to an ageing population in the Western world. Over the decades, the scientific perception of OA has shifted from a simple degeneration of cartilage and bone to a multifactorial disease involving various cell types and immunomodulatory factors. Despite a wide range of conventional treatment modalities available, a significant proportion of patients remain treatment refractory. Low-dose radiotherapy (LDRT) has been used for decades in the treatment of patients with inflammatory and/or degenerative diseases and has proven a viable option even in cohorts of patients with a rather poor prognosis. While its justification mainly derives from a vast body of empirical evidence, prospective randomized trials have until now failed to prove the effectiveness of LDRT. Nevertheless, over the decades, adaptions of LDRT treatment modalities have evolved using lower dosages with establishment of different treatment schedules for which definitive clinical proof is still pending. Preclinical research has revealed that the immune system is modulated by LDRT and very recently osteoimmunological mechanisms have been described. Future studies and investigations further elucidating the underlying mechanisms are an essential key to clarify the optimal patient stratification and treatment procedure, considering the patients' inflammatory status, age, and sex. The present review aims not only to present clinical and preclinical knowledge about the mechanistic and beneficial effects of LDRT, but also to emphasize topics that will need to be addressed in future studies. Further, a concise overview of the current status of the underlying radiobiological knowledge of LDRT for clinicians is given, while seeking to stimulate further translational research.

[Hand Osteoarthritis - Clinical Picture and Current Management]

Hand Osteoarthritis - Clinical Picture and Current Management Abstract. Finger joint osteoarthritis (HOA) is a common joint disease that increases with age. The cause is polyethiological. The distal joints of the fingers are most frequently affected, followed by the carpometacarpal joint of the thumb, the proximal interphalangeal joints, and the metacarpophalangeal joints. The clinical symptoms of HOA are painful functional restrictions of the hand and fingers. In terms of therapy, lifestyle modifications and exercise are primarily recommended. Only when these measures are inadequate or not helpful drugs will be recommended be recommended. First-choice drugs are non-steroidal anti-inflammatory drugs applied topically or p.o. Pharmaceutically manufactured chondroitin preparations are also helpful. In severely painful or erosive forms of HOA, corticosteroids can be used intra-articularly. The status of laser therapy or fractionated radiation is (still) unclear. Classical disease-modifying drugs such as those used in inflammatory joint diseases have no therapeutic value. Surgical interventions should be considered if conservative treatments are not sufficiently helpful and hand function is significantly impaired.

Radon Improves Clinical Response in an Animal Model of Rheumatoid Arthritis Accompanied by Increased Numbers of Peripheral Blood B Cells and Interleukin-5 Concentration

Radon treatment is used as an established therapy option in chronic painful inflammatory diseases. While analgesic effects are well described, little is known about the underlying molecular effects. Among the suspected mechanisms are modulations of the anti-oxidative and the immune system. Therefore, we aimed for the first time to examine the beneficial effects of radon exposure on clinical outcome as well as the underlying mechanisms by utilizing a holistic approach in a controlled environment of a radon chamber with an animal model: K/BxN serum-induced arthritic mice as well as isolated cells were exposed to sham or radon irradiation. The effects on the anti-oxidative and the immune system were analyzed by flow-cytometry, qPCR or ELISA. We found a significantly improved clinical disease progression score in the mice, alongside significant increase of peripheral blood B cells and IL-5. No significant alterations were visible in the anti-oxidative system or regarding cell death. We conclude that neither cell death nor anti-oxidative systems are responsible for the beneficial effects of radon exposure in our preclinical model. Rather, radon slightly affects the immune system. However, more research is still needed in order to fully understand radon-mediated effects and to carry out reasonable risk-benefit considerations.