At Clearwater Radiation Oncology, we are a state-of-the-art Radiation Therapy Center using low-dose radiotherapy to successfully reduce pain and discomfort for multiple noncancerous and benign conditions such as:
- Osteoarthritis
- Tendonitis
- Plantar Fasciitis
- Dupuytren’s Contracture
- Desmoid Tumor
- Keloids
- Bursitis
- Achilles Tendinitis
- Tennis Elbow
- Rotator Cuff Syndrome
- Paraganglioma
- And Gynecomastia to name a few
To see our specialists and have a patient-centered discussion about what options are best suited for your disease, call for a consult today at ……
Low Dose Radiotherapy for Osteoarthritis: An Alternative Noninvasive, Cost-Effective, Treatment with Great Therapeutic Results and Minimal Side Effects
Osteoarthritis (OA) is known to be a progressively debilitating disorder commonly presenting with symptoms of pain, loss of mobility, joint stiffness, and fatigue. It is the second leading cause of disability, the second-most costly health condition, and the fastest increasing medical condition in the United States. The incidence and prevalence of OA are expected to continuously rise parallel to an aging population, with 1 in 7 Americans living with a diagnosis of OA at present.
Currently, there is no definitive intervention for addressing early-stage OA given that the etiology is multifactorial, and the exact disease mechanism is still not completely understood. Since there are no universal guidelines for the specific sequencing or combination of therapies, interventions usually differ among patients. At first, conservative therapies are utilized, such as weight loss, physical rehab, and keeping up with moderate levels of physical activity. If OA is resistant to such approaches, Nonsteroidal anti-inflammatory drugs (NSAIDS) are then given as a trial for relief. However, long term NSAIDS are associated with their own complications, such as gastrointestinal bleeds, cardiovascular events, and possible renal failure.
Fortunately, low-dose radiotherapy (LDRT) has now positioned itself as an acceptable and effective therapeutic alternative for patients with OA, as seen in multiple clinical trials that have exhibited symptomatic pain relief in 63 to 90% of all irradiated patients. These same studies reveal very minimal to no acute or late side effects, with some publications showing only mild skin redness as a presenting symptom. In addition, LDRT has not shown to have a negative impact on the function of noninflamed joints, or is it a contraindication for a subsequent surgical intervention.
So, how can LDRT play a role for OA in patients today? Currently, LDRT is gaining utilization for refractory OA that has exhausted other first-line medical interventions, or even delivered before a more invasive procedure, such as a joint replacement. LDRT fills in the sweet spot for patients who are resistant to benign interventions, most likely require a more aggressive intervention, but would like to trial a more conservative treatment approach first. LDRT would also not be a burden to the patient’s life, since a RT course is usually consisting of only 2-3 treatments a week for a total of 2 weeks.
Have you had it with OA and the disability it causes? Is nothing working for your OA? Are you running out of therapeutic options, and do not want to pursue an aggressive intervention yet? If yes to any of the above, then Low-dose RT might be for you. It is a noninvasive, cost-effective, treatment with minimal side effects and good therapeutic results.
If you would like to learn more about LDRT for OA and consult with a local Radiation Oncologist, visit Clearwater Radiation Oncology at https://clearwaterradiation.com or call 727-966-HOPE (4673) and ask for Dr. Rahul Bhandari. He will be happy to shed more light on how LDRT can better help you and your Osteoarthritis.
Response of radiation therapy to erosive osteoarthritis: a case report
Brian Behnke DO, Pallavi Velagapudi DO, Rahul Bhandari MD, Rodney Daniel MD
Introduction
Erosive osteoarthritis (OA) is a more severe form of osteoarthritis, that often involves the hands, usually the distal interphalangeal joints and proximal interphalangeal joints
with imaging showing central erosions with saw tooth and gull wing deformities (1). Currently there is no cure for OA, including erosive OA, as the etiology of the disease is multifactorial. The goal of current therapy is alleviation of symptoms and improvement of quality of life. Radiation therapy has been used to treat skeletal diseases in Europe for many years, especially in Germany and Spain. However, it has not yet gained momentum in the United States. We present a case of a patient treated with radiation therapy to show the positive impact it can have as a treatment method for patients with osteoarthritis.
Introduction
The patient was re-evaluated at 12 weeks post-treatment. At her follow-up, her pain was a 0/10 in her bilateral hands. Due to her success with treatment, she opted to continue with low-dose palliative therapy for her bilateral knees due to uncontrolled pain from OA, which has provided relief.
Figures
Introduction
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- The prevalence of erosive OA in the general population is 2.8%, compared to 10.2% in those with symptomatic OA. (2). Treatments include reducing risk factors, intraarticular treatments, physical treatments, alternative therapies, and surgical therapy
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- Low dose radiation therapy has been shown in multiple clinical trials to reduce pain in 63-90% of patients, without acute side effects (3).
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- The exact pathophysiology of analgesia after radiation therapy is currently being explored, but studies show that low doses of radiation alter multiple inflammatory pathways at the cellular level. (4)
- Low dose radiation therapy inhibits nitric oxide production via inhibition of nitric oxide synthetase, which decreases the role of macrophages in the inflammatory pathway. Lower doses of radiation (less than 1 Gy) push macrophages towards an anti-inflammatory phenotype while high doses lead to a proinflammatory phenotype. Low dose radiation therapy also reduces adhesion of leukocytes, so there is less cellular migration, and reduces proinflammatory cytokine production from irradiated leukocytes. (3)
- Radiation therapy has been proven to have dosedependent therapeutic effects. Conventional and hypofractionated radiation therapy have antiproliferative effects that are beneficial in treating malignancy while low dose radiation therapy of less than 1 Gray per fraction have anti-inflammatory effects (3)
- An update from the German Society of Radiation Therapy and Oncology reports that there have been no known or reported cases of secondary malignancy from treatment with radiation therapy for osteoarthritis. (3)
Conclusions
This case provides an example that demonstrates the benefit of radiation therapy. It is a long term solution for moderate to severe pain relief with improvement in quality of life and mobility for those suffering from erosive OA as well as degenerative OA. As there is no definitive treatment for osteoarthritis besides arthroplasty, it is important to consider radiation therapy as a valuable modern treatment for erosive osteoarthritis.
References
1.Favero M, Belluzzi E, Ortolan A, Lorenzin M, Oliviero F, Doria A, Scanzello CR, Ramonda R. Erosive hand osteoarthritis: latest findings and outlook. Nat Rev Rheumatol. 2022 Mar;18(3):171-183. doi: 10.1038/s41584-021-00747-3. Epub 2022 Feb 1. PMID: 35105980. 2. Marshall M, Nicholls E, Kwok W, et al. Erosive osteoarthritis: a more severe form of radiographic hand osteoarthritis rather than a distinct entity? Annals of the Rheumatic Diseases2015;74:136-141. https://ard.bmj.com/content/74/1/1363. Dove A, Cmelak A, Darrow K, McComas K, Chowdhary M, Backta J, Kirschner A. The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review. International Journal of Radiation Oncology Phys, Vol 114, No 2, pp 2-3-220 (2022). https://doi.org/10.1016/j.ijrobp.2022.04.0294. Beatriz Alvarez, Angel Montero, Ovidio Hernando, Raquel Ciervide, Juan Garcia, Mercedes Lopez, Mariola Garcia-Aranda, Xin Chen, Ines Flores, Emilio Sanchez, Jeannette Valero, Alejandro Prado, Rosa Alonso, Leyre Alonso, Pedro Fernandez-Leton, Carmen Rubio, Radiotherapy CT-based contouring atlas for non-malignant skeletal and soft tissue disorders: a practical proposal from Spanish experience,British Journal of Radiology, Volume 94, Issue 1124, 1 August 2021, 20200809,
RADIATION THERAPY FOR DUPUYTREN’S CONTRACTURE
Dupuytren’s Contracture (DC) is a benign disease, also known as Viking’s Disease, that affects the connective tissue of the fingers and palms. First presenting as simple knots on the hands, overtime they slowly progress to firm cords along the tendons and palm. When thickened, these cords then start contracting and causing flexion and deformations of the affected fingers. This will naturally cause discomfort, pain, and loss of function of the affected hand.
Radiation Therapy (RT), through growing publications and patient experiences, is proving to be an extremely effective treatment modality for the early stages of Dupuytren’s Contractures if it meets any of these criteria:
- There is less than 10 degrees of fixed finger bending. If more than 10 degrees of finger bending, surgical intervention is preferred
- The disease has become prominently worse over the previous 6-12 months
Why Choose Radiation Therapy for Dupuytren’s Contracture?
Even though radiation therapy is just recently becoming implemented as a successful treatment choice for Dupuytren’s Contracture here in the United States, it has been used safely and effectively in Europe for quite some time now. For example, in the United Kingdom, the National Institute for Health and Clinical Excellence in 2010 approved RT to treat DC. One landmark study showed 80% of patients improved and/or stopped progressing, while only 8% required surgery, eight years after completion of RT. On the other hand, 62% of patients who did not undergo RT had a disease progression and 30% of them needed surgery within 5 years.
Radiation Therapy Details:
Radiation Therapy is administered externally, so it is completely painless and noninvasive for the patient.
The radiation therapy is prescribed over two sessions, which are given 6-8 weeks apart. Each of the two sessions consists of 5 days of consecutive treatments lasting only approximately 15 minutes each.
Given that there are no vital organs or structures in or near the hand, radiation therapy is commonly well-tolerated with minimal side effects. Potential side effects include mild redness, dryness, or soreness of the treated area, which commonly resolve.
If your patient would like to learn more about Radiation Therapy for their diagnosis of Dupuytren’s Contracture and consult with a local Radiation Oncologist, visit Clearwater Radiation Oncology at https://clearwaterradiation.com or call 727-966-HOPE (4673) and ask for Dr. Rahul Bhandari. He will be happy to shed more light on how RT can better help these patients and their treatable disease.
