The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis

Abstract

The purpose of this work was to evaluate the efficacy of low-dose radiotherapy (RT) for thumb carpometacarpal osteoarthritis (rhizarthrosis). The responses of 84 patients (n = 101 joints) were analyzed 3 months after therapy (n = 65) and at 12 months (n = 27). Patients were treated with 6 fractions of 1 Gy, two times a week, with a linear accelerator. At the end of therapy, about 70 % of patients reported a response (partial remission or complete remission), 3 months later about 60 %, and 1 year after treatment 70 %. In univariate regression analysis, higher patient age and field size greater than 6 × 4 cm were associated with response to treatment, while initial increase of pain under treatment was predictive for treatment failure. Duration of RT series (more than 18 days), gender, time of symptoms before RT, stress pain or rest pain, or prior ortheses use, injections, or surgery of the joint were not associated with treatment efficacy. In multivariate regression analysis, only field size and initial pain increase were highly correlated with treatment outcome. In conclusion, RT represents a useful treatment option for patients suffering from carpometacarpal osteoarthritis. In contrast to other benign indications, a larger field size (>6 × 4 cm) seems to be more effective than smaller fields and should be evaluated in further prospective studies.

Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial

“…These studies had heterogeneous study populations including a variety of benign diseases and using poorly defined outcome measures. Other clinical studies did report beneficial effects of LDRT on pain and functioning 24,46 . However, these studies had inferior study designs (e.g., no control-arm, non-validated outcome measures, poorly defined study population), with high risk of bias.…”

Prospective Evaluation of Surgery vs. Low Dose External Beam Radiotherapy for Painful Thumb Carpometacarpal Osteoarthritis – A Study Protocol

“…We suppose a response to therapy of about 70% [5,7] for both investigated treatments. The sample size calculations revealed a necessary minimum study population of 61 patients to be recruited for each therapy for a p-value pf 0.05 and 80% power, respectively (analysis with GPower 3.1 according to Faul [9].…”

“…In Germany and Central Europe low-dose external beam radiotherapy (LD-EBRT) for painful degenerative diseases of the joints and tendons is widely adopted [6]. It has been established in the therapy of painful CMC arthrosis, too [7].…”

“…The lifetime risk of a fatal radiation-induced cancer is negligible (lower than 0.3 per 1000) as most of the patients are older than 50 years [8]. In a collective of 84 patients (101 joints) treated with LD-EBRT, 70% reported amelioration of symptoms up to one year after therapy [7].…”

Class IV laser therapy for trapeziometacarpal joint osteoarthritis: Study protocol for a randomized placebo‐controlled trial

“…Scientific background to support therapeutic management of patient with TCMC-OA exists at various levels of evidence. The traditional mainstay for conservative therapeutic management includes orthotic support (Hermann et al, 2014), pharmacological approach (Joshi, 2005;Salini, De Amicis, Abate, Natale, & Di Iorio, 2009), patient education (Stamm et al, 2002), therapeutic exercise (Valdes & von der Heyde, 2012), joint (Villafañe, Silva, & Fernandez-Carnero, 2012) and neural (Villafañe, Silva, & Fernandez-Carnero, 2011) mobilization, or radiotherapy (Kaltenborn, Bulling, Nitsche, Carl, & Hermann, 2016) among others, both isolated or in combination (Deveza et al, 2017). Although a number of them have shown to be effective, most of existing trials on TCMC-OA have demonstrated poor consistent case definition, sparse standardized outcome measures, and inadequate powering, thereby limiting their generalizability to clinical scenarios (Spaans et al, 2015).…”