Benign diseases Radiotherapy

Benign diseases that can be treated with radiotherapy can be divided into different types, specifically degenerative, inflammatory, hyperproliferative and functional diseases or dysfunctions.

Examples of this are the commonly known tennis elbow or heel spurs, or the resulting inflammatory change in the sole of the foot (plantar fasciitis). These conditions can be caused by chronic overuse (tennis elbow), obesity, prolonged standing or poor footwear (heel spur). Chronic plantar fasciitis is often caused by a misalignment of the foot (abnormal pronation of the foot). The resulting stretching of the foot tendons (plantar aponeurosis) leads to microtrauma, especially in the area of the calcaneus tendon, which ultimately promotes the development of a heel spur.

Our most important goal is to offer you the best possible treatment with the best possible results. In our clinic, we regularly treat patients with benign diseases and have been able to gain very good experience in this area. We work closely and trustingly with specialists from other disciplines such as orthopaedists, orthopaedic rheumatologists, rheumatologists, surgeons, ophthalmologists and ophthalmologists. We also regularly exchange information with leading centers and renowned radio-oncologists in this field.

Effect of radiotherapy

Clinical studies have confirmed that even very low-dose radiotherapy can be an effective treatment for benign diseases (Niewald et al). Heel spurs or chronic Fasciitis plantaris is treated with 3 – 6 therapy sessions, the radiation dose is extremely low at 0.5-1 Gray (Gy) each. This results in a treatment duration of approx. two weeks, which can be repeated after six weeks if necessary to achieve better results.

Studies have shown improvements in pain symptoms of around 85% immediately after treatment and up to 90% after six weeks (Ott et al). These values correspond to our many years of positive clinical experience and are all the more remarkable as many patients come to us late and a large number of previous treatments have not been successful.

These radiation treatments are generally very well tolerated due to the low dose and hardly any side effects are expected. In the following we would like to give you an overview of benign diseases which we regularly treat in our daily practice and which represent a good indication for radiotherapy:

Indications for treatment

Radiotherapy is used for benign diseases after careful consideration of the opportunities and risks and is usually used when other treatment options, such as medication or surgery, are not an option. In principle, a very good result can be achieved with a comparatively low dose and excellent tolerability.

Degenerative/inflammatory joint and soft tissue diseases

Epicondylopathia humeri (tennis elbow)/ periarthropathia humeroscapularis (shoulder syndrome):

  • Indication for radiotherapy for refractory disease
  • Low-dose radiotherapy with 6 x 0.5 Gy for pain treatment

Fasciitis plantaris (heel spur):

  • Indication for radiotherapy after conservative measures have been exhausted
  • Low-dose radiotherapy with 6 x 0.5 Gy for pain treatment

Hyperproliferative diseases

Dupuytren’s disease:

  • Radiation indication in the initial stage (N/I) without relevant flexion contracture
  • Low-dose radiotherapy with 10 x 2 Gy to prevent further progression

Ledderhose disease:

  • Indication for radiotherapy in clinically progressive disease at an early stage
  • Low-dose radiotherapy with 10 x 2 Gy to prevent further fibrosis

Induratio penis plastica (Peyronie’s disease):

  • Radiation indication for soft plaques at an early stage
  • Low-dose radiotherapy with 10 x 2 Gy to prevent penile deviation

Endocrine orbitopathy:

  • Radiation indication in the acute phase of the disease, with or without a combination of glucocorticoids
  • Proven dose 8-10 x 2 Gy, more recent data already promise benefit from 8 x 0.3 Gy

Risks of radiotherapy

After radiotherapy, there is a slightly increased risk of developing an ulcer induced by the radiation. For this reason, patients with benign diseases are preferably irradiated in our department from the age of > 50 years. Between the ages of 30 and 50, conservative measures should be fully exhausted beforehand (see diagram).

Diagramm zur Strahlenindikation

  • Randomized, multicenter trial on the effect of radiation therapy on plantar fasciitis (painful heel spur) comparing a standard dose with a very low dose: mature results after 12 months’ follow-up (Niewald M, Int J Radiat Oncol Biol Phys. 2012).
  • Radiotherapy for benign achillodynia, Long-term results of the Erlangen Dose Optimization Trial (Ott et al., Strahlenther Onkol 2015)
  • Benign painful elbow syndrome. First results of a single center prospective randomized radiotherapy dose optimization trial (Ott et al., Strahlenther Onkol. 2012)
  • Retrobulbar irradiation for thyroid-associated orbitopathy: double-blind comparison between 2.4 and 16 Gy. (Gerling et al., Int J Radiat Oncol Biol Phys. 2003)
  • Radiotherapy for benign achillodynia, Long-term results of the Erlangen Dose Optimization Trial (Ott et al., Strahlenther Onkol 2015)

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