Radiotherapy in Osteo-arthritis
Managing pain with osteoarthritis can be a challenge. For some osteoarthritis patients, low-dose radiation therapy (LD-RT) may be used for pain management as an alternative treatment after other methods have not worked.
Studies show a pain improvement rate of over 70 percent after the initial set of treatments, and most patients reported lasting pain relief upto two years after beginning LD-RT.
This modality is non-invasive that is no surgery or needle pricks are involved, and can be repeated as needed.
The Kathmandu Cancer Center, in line with global advancements, is exploring the adoption of LDRT to provide relief from chronic pain and functional impairments associated with these conditions. The center is poised to position itself at the forefront of this innovative treatment in Nepal.
Indications for Low-dose radiotherapy
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Osteoarthritis (OA)
LDRT has shown particular promise in treating osteoarthritis, particularly in joints such as the knee, hand, and shoulder. Patients suffering from chronic pain and joint stiffness, who have failed to achieve relief from conservative methods, are ideal candidates for LDRT.
- Target areas: Knees, hands, hips, ankles, and shoulders.
- Symptoms addressed: Chronic pain, reduced mobility, and joint inflammation.
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Tendinopathies and tendinitis
Conditions such as lateral epicondylitis (tennis elbow) and Achilles tendinitis are also responsive to LDRT. The anti-inflammatory properties of radiation make it a useful tool for managing persistent inflammation and pain in these areas.
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Bursitis
Bursitis, which involves the inflammation of the bursae (fluid-filled sacs cushioning the bones, tendons, and muscles), often leads to significant pain. LDRT serves as a therapeutic option when other interventions, such as steroid injections, have failed.
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Plantar Fasciitis
This common heel pain condition has been another focus of LDRT research. When conservative treatments fail, LDRT provides a non-invasive, effective alternative for long-term symptom relief.
Mechanism of Action
LDRT's anti-inflammatory effects are mediated through the reduction of pro-inflammatory cytokines, such as IL-1 and TNF-alpha, which are responsible for the chronic pain and swelling experienced in conditions like osteoarthritis. Additionally, LDRT improves angiogenesis (formation of new blood vessels) in the affected tissues, potentially improving tissue healing and oxygenation, which may enhance joint function and reduce pain.
Risks of Radiotherapy
The radiotherapy doses are very low, resulting in mild side effects such as skin reddening and soreness, which quickly resolve. There is a very small risk of radiation-induced cancers, with a lifetime risk of approximately 0.1%, mainly of skin basal cell carcinoma. The risk decreases with increasing age. There are no issues in doing surgery to irradiated site later on after LDRT.
Results and Efficacy
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Osteoarthritis
In multiple studies, LDRT has demonstrated efficacy in reducing pain and improving joint function in osteoarthritis patients. Results indicate a pain reduction from 7/10 to 3/10 on a numerical scale in many cases. Furthermore, 72% of patients in clinical studies reported significant pain relief and enhanced mobility after treatment.
Notable outcomes:
- 80-90% of patients experience meaningful improvements in pain and joint function.
- Effects typically last between 6 months to 2 years, with some patients requiring repeat treatment.
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Tendinopathies
Results in patients with tennis elbow and rotator cuff tendinopathy show a marked improvement in pain levels, with over 70% of patients experiencing symptomatic relief.
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Bursitis
Clinical outcomes in bursitis cases treated with LDRT reveal similar improvements in pain reduction, with a 68% success rate in pain alleviation across multiple studies.
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Plantar Fasciitis
Randomized studies show effective symptom management with LDRT, where both standard and lower-dose treatments have led to significant improvements in heel pain, with response rates between 70-80%.
Major Benefits of RT
- Improvements in pain relief, joint function, and quality of life
- Non-invasive treatment, beneficial for patient with significant comorbidities
- Rapid response and long lasting effects typically 1-2 years, significantly improves patient satisfaction and outcomes
Conclusion and Future Directions
As Kathmandu Cancer Center looks toward expanding its treatment offerings, LDRT represents a groundbreaking addition to its clinical services. Given the robust evidence supporting the effectiveness of LDRT in managing chronic pain associated with benign musculoskeletal conditions, this treatment has the potential to significantly enhance the quality of life for patients in Nepal.
The center can further position itself as a regional leader by integrating LDRT into its multidisciplinary approach, offering a beacon of hope for those suffering from conditions like osteoarthritis and plantar fasciitis, where conventional therapies fall short. By collaborating with orthopedic specialists and enhancing public awareness, Kathmandu Cancer Center will lead the way in providing innovative care solutions.
Introduction to Low-Dose Radiotherapy (LDRT) in Nepal
Kathmandu Cancer Center is exploring the integration of LDRT to enhance its treatment offerings. With its proven efficacy in reducing chronic pain and improving mobility, LDRT could provide a much-needed solution for patients suffering from conditions like osteoarthritis (OA) and plantar fasciitis.
For more information, contact us
Conditions Treated by LDRT
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Osteoarthritis (OA)
LDRT has shown remarkable results in treating OA, particularly in joints like the knee, hand, hip, and shoulder. It reduces pain and inflammation, providing relief to patients who have exhausted other therapeutic options.
- Target Areas: Knees, hands, hips, ankles, shoulders.
- Symptoms Addressed: Chronic pain, joint stiffness, reduced mobility.
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Tendinopathies and Enthesopathies
Conditions such as tennis elbow (lateral epicondylitis) and Achilles tendinitis respond well to LDRT. The treatment reduces persistent inflammation and alleviates pain.
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Bursitis
Bursitis causes inflammation of the bursae, leading to significant discomfort. When conventional treatments fail, LDRT offers an effective alternative for pain management.
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Plantar Fasciitis
For patients with chronic heel pain that doesn't respond to conservative treatments, LDRT provides long-term symptom relief.
Efficacy of Low dose RT in Various Conditions
| Condition | Pain Reduction (%) | Mobility Improvement (%) | Duration of relief | |
|---|---|---|---|---|
| Osteoarthritis | 70-90% | 60-80% | 1-2 years | |
| Tendinopathies | 70% | N/A | 6-12 months | |
| Bursitis | 68% | N/A | 6-12 months | |
| Planter-fascitis | 70-80% | N/A | 1-2 years |
| Study | Sample Size | Joints Treated | Dose & Fractionation | Pain Reduction (%) |
|---|---|---|---|---|
| Ruhle et al (2021) | 1185 | Multiple joints | 6 Gy (1 Gy/fraction) | 65.6% at 8 weeks |
| Alvarez et al (2021) | 100 | Hand | 6 Gy (1 Gy/fraction) | 94% at 12 months |
| Hautmann et al (2020) | 295 | Multiple joints | 6 Gy (1 Gy/fraction) | 64.8% at 24 months |
Suggested criteria for treatment with LDRT for Osteoarthritis
- Appropriate after the exhaustion of other medical interventions or before more aggressive interventional treatments such as joint replacement (if more conservative treatment is desired)
- Older than age 40
- No known contraindications to radiation (pregnancy, active connective tissue disorder)
German 2018 DEGRO level of recommendation
- Knee OA Level recommendation B
- Hip OA Level recommendation C
- Hand OA Level recommendation C
- Ankle OA No level recommendation given
- Shoulder OA Level recommendation C
- Plantar fasciitis Level recommendation A
- Elbow syndrome Level recommendation B
Abbreviations: DEGRO = German Society of Radiation Therapy and Oncology; LDRT = low-dose radiation therapy; OA = osteoarthritis.
Safety Considerations
- Secondary Malignancy: The risk is extremely low, particularly in older patients. Studies estimate the lifetime risk of radiation-induced cancers, such as basal cell carcinoma, to be approximately 0.1%.
- Acute Side Effects: In over 1,000 patients studied, only mild skin redness has been reported, with no long-term adverse effects noted.
Conclusion
LDRT has emerged as a powerful tool in the management of osteoarthritis and other benign conditions. Currently, there are strong data to suggest a benefit of LDRT in plantar fasciitis, with about 80% efficacy in pain reduction. Additionally, there are data to suggest benefit in other musculoskeletal disorders, such as trochanteric bursitis, medial and lateral epicondylitis, tendinopathies of various joints, Dupuytren contracture, Ledderhose disease, heterotopic ossification, and other disorders.
"The aim of treating these nonmalignant conditions is to restore function and improve quality of life."