Radiation therapy for benign diseases: patterns of care study in Germany

Seegenschmiedt, M. Heinrich; Katalinic, Alexander; Makoski, H. B.; Haase, Wulf; Gademann, G.; Hassenstein, E

doi:10.1016/s0360-3016(99)00537-4

Cited by 117 publications

(96 citation statements)

References 22 publications

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“…This study has highlighted the importance of close monitoring of this cohort and demonstrates that, where possible, the dose to the chest wall/breast should be minimized. 70 In a modeling study of the risk of RIC following intermediate dose RT (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) for mediastinal Hodgkin lymphoma, a marked reduction in the risk of subsequent breast and lung cancer was calculated when involved field RT was compared with mantle/extended field RT. This study demonstrated that care in reducing the field size to a minimum, use of modern RT techniques and dose reduction (where justified) will significantly reduce the subsequent risk of a RIC.…”

Section: Irradiation Of the Chest Areamentioning

confidence: 99%

“…27 By contrast, RT departments in Germany have a long tradition of using RT for benign indications and a significant proportion of relevant publications come from this country. [28][29][30] We have recently reviewed the evidence for the effectiveness of RT for benign disease and provided, where appropriate, recommended treatment protocols. 10 It is hoped that clinical oncologists will now reconsider the use of the protocols for these specific conditions, although in many cases, their use is predicated on referral from other consultants (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

McKeown

Hatfield

Prestwich

et al. 2015

BJR

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Most radiotherapy (RT) involves the use of high doses (.50 Gy) to treat malignant disease. However, low to intermediate doses (approximately 3-50 Gy) can provide effective control of a number of benign conditions, ranging from inflammatory/proliferative disorders (e.g. Dupuytren's disease, heterotopic ossification, keloid scarring, pigmented villonodular synovitis) to benign tumours (e.g. glomus tumours or juvenile nasopharyngeal angiofibromas). Current use in UK RT departments is very variable. This review identifies those benign diseases for which RT provides good control of symptoms with, for the most part, minimal side effects. However, exposure to radiation has the potential to cause a radiation-induced cancer (RIC) many years after treatment. The evidence for the magnitude of this risk comes from many disparate sources and is constrained by the small number of long-term studies in relevant clinical cohorts. This review considers the types of evidence available, i.e. theoretical models, phantom studies, epidemiological studies, longterm follow-up of cancer patients and those treated for benign disease, although many of the latter data pertain to treatments that are no longer used. Informative studies are summarized and considered in relation to the potential for development of a RIC in a range of key tissues (skin, brain etc.). Overall, the evidence suggests that the risks of cancer following RT for benign disease for currently advised protocols are small, especially in older patients. However, the balance of risk vs benefit needs to be considered in younger adults and especially if RT is being considered in adolescents or children.

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Section: Irradiation Of the Chest Areamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

McKeown

Hatfield

Prestwich

et al. 2015

BJR

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“…Radiotherapy with fractions of mostly 0.3-1.0 Gy and a total dose of 3-12 Gy exerted anti-inflammatory and analgesic effects for painful degenerative disorders. Relatively low dose radiotherapy for joint inflammation was an effective and less toxic alternative to steroids and low dose chemotherapy drugs in treating arthritis (von Pannewitz 1933;Seegenschmiedt et al 2000;Micke and Seegenschmiedt 2002;Niewald et al 2008). Low doses of radiation were effective in treating ulcerative colitis if given chronically over a longer period of time (Mitchel et al 2007).…”

Section: Low Dose Radiotherapy For Inflammatory and Proliferative Dismentioning

confidence: 99%

Potential Treatment of Inflammatory and Proliferative Diseases by Ultra-Low Doses of Ionizing Radiations

Sanders¹

2012

Dose-Response

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ᮀ Ultra-low doses and dose-rates of ionizing radiation are effective in preventing disease which suggests that they also may be effective in treating disease. Limited experimental and anecdotal evidence indicates that low radiation doses from radon in mines and spas, thorium-bearing monazite sands and enhanced radioactive uranium ore obtained from a natural geological reactor may be useful in treating many inflammatory conditions and proliferative disorders, including cancer. Optimal therapeutic applications were identified via a literature survey as dose-rates ranging from 7 to 11µGy/hr or 28 to 44 times world average background rates. Rocks from an abandoned uranium mine in Utah were considered for therapeutic application and were examined by γ-ray and laser-induced breakdown fluorescence spectroscopy. The rocks showed the presence of transuranics and fission products with a γ-ray energy profile similar to aged spent uranium nuclear fuel (93% dose due to β particles and 7% due to γ rays). Mud packs of pulverized uranium ore rock dust in sealed plastic bags delivering bag surface β,γ dose-rates of 10-450 µGy/h were used with apparent success to treat several inflammatory and proliferative conditions in humans.

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“…19,32,[37][38][39] Low-dose radiotherapy has significant antiinflammatory effects, perhaps in part because it reduces the adherence of monocytes to endothelial cells or decreases neutrophil function. 20,27,41 Between 1994 and 1996, ~ 13,000 patients underwent low-dose radiotherapy for inflammatory osteoarthritic disorders, 37 and between 2001 and 2002, this number nearly doubled. 39 Centers in Europe generally follow published consensus guidelines for treatment of osteoarthritic and inflammatory conditions with low-dose radiotherapy.…”

Section: Neurosurg Focus / Volume 23 / December 2007mentioning

confidence: 99%

CyberKnife rhizotomy for facetogenic back pain: a pilot study

Li¹,

Patil²,

Adler³

et al. 2007

FOC

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Object By targeting the medial branches of the dorsal rami, radiofrequency ablation and facet joint injections can provide temporary amelioration of facet joint–producing (or facetogenic) back pain. The authors used CyberKnife radiosurgery to denervate affected facet joints with the goal of obtaining a less invasive yet more thorough and durable antinociceptive rhizotomy. Methods Patients with refractory low-back pain, in whom symptoms are temporarily resolved by facet joint injections, were eligible. The patients were required to exhibit positron emission tomography–positive findings at the affected levels. Radiosurgical rhizotomy, targeting the facet joint, was performed in a single session with a marginal prescription dose of 40 Gy and a maximal dose of 60 Gy. Results Seven facet joints in 5 patients with presumptive facetogenic back pain underwent CyberKnife lesioning. The median follow-up was 9.8 months (range 3–16 months). The mean planning target volume was 1.7 cm3 (range 0.9–2.7 cm3). A dose of 40 Gy was prescribed to a mean isodose line of 79% (range 75–80%). Within 1 month of radiosurgery, improvement in pain was observed in 3 of the 5 patients with durable responses at 16, 12, and 6 months, respectively, of follow-up. Two patients, after 12 and 3 months of follow-up, have neither improved nor worsened. No patient has experienced acute or late-onset toxicity. Conclusions These preliminary results suggest that CyberKnife radiosurgery could be a safe, effective, and non-invasive alternative to radiofrequency ablation for managing facetogenic back pain. No patient suffered recurrent symptoms after radiosurgery. It is not yet known whether pain relief due to such lesions will be more durable than that produced by alternative procedures. A larger series of patients with long-term follow-up is ongoing.

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Radiation therapy for benign diseases: patterns of care study in Germany

Cited by 117 publications

References 22 publications

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

Potential Treatment of Inflammatory and Proliferative Diseases by Ultra-Low Doses of Ionizing Radiations

CyberKnife rhizotomy for facetogenic back pain: a pilot study

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