Background Low dose Radiotherapy (LD-RT) is used for treating non-malignant diseases since its introduction in the late 19th century.1 Currently, osteoarthritis (OA) is a well-accepted indication for LD-RT in more than 80% of the radio-therapeutic centres in Eastern Europe.2 In Germany, over 9,000 patients with OA are treated with RT annually.3 LD-RT is considered safe, as the total dose that is used for these patients is relatively small; the effective dose is comparable to an abdominal CT-scan.4 Furthermore, the dose for treating OA is targeted on the affected joint, minimising the risk for exposure of other tissues. Multiple studies using animal models show that LD-RT reduces inflammation in OA.5
Despite high acceptance in large parts of the world and widespread use, the level of evidence on the effect of radiotherapy on pain and function in OA patients remains unclear.
Objectives To systematically review literature findings on the effect of radiotherapy on pain and function in patients with osteoarthritis.
Methods A computerised search with broad search terms was performed in the PubMed, EMBASE and Web of Science databases. Primary inclusion criteria were: osteoarthritis as indication for treatment, radiotherapy as intervention, written in English, German or Dutch and published since 1980. Literature overviews were excluded. Study quality was assessed using the EPHPP Quality Assessment Tool for Quantitative Studies (scale: strong, moderate, weak). Screening for eligibility and quality assessment was performed independently by MM and CvdE. Results were extracted by MM and are presented as reported in the original publication. Short-term (≤3months) and long term (>3months) results are presented separately.
Results The literature search generated 6,124 citations. Seven studies were suitable for inclusion, all with retrospective observational design and without control group. The main results are shown in Table 1. The methodological quality of all studies was judged as weak. The age of included OA patients ranged from 30 to 90 years, the duration of their complaints ranged from <0.5 to 15 years. As intervention, most studies used 2-3 RT-sessions per week for two weeks, some with a pause of six weeks before this was repeated. Overall, a dose of 0.5-1.0 Gy per session was applied, with a total dose of 3.5-6.0 Gy. In general, non-validated single-item measurement instruments were used to evaluate the effect of RT on pain. Orthopaedic scores were used to assess functioning in three studies. One study reported on side effects, none occurred.
Conclusions The included studies reported positive results of LD-RT on pain and functioning. Little is known about its side effects. The strength of evidence is very weak due to inferior study designs and outcome measures. Considering the widespread use of radiotherapy for OA and the effects reported in animal studies, a high quality RCT with well-defined outcome measures is warranted.
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Disclosure of Interest None declared
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