Micke Oliver, Seegenschmiedt M Heinrich
Department of Radiotherapy, Münster University Hospital, Münster, Germany.
Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):828-43. doi: 10.1016/S0360-3016(03)01620-1.
After a general patterns of care study, the German Cooperative Group on Radiotherapy for Benign Diseases conducted a multicenter cohort study to analyze radiotherapy (RT) in painful heel spur syndrome (HSS).
In 2001, a patterns of care study was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful HSS were assessed. In addition, the functional and subjective outcomes were evaluated.
Of the institutions, 146 (79.3%) returned the questionnaire: 10 (6.8%) reported no clinical experience with RT for HSS, and 136 (93.2%) treated 3621 patients annually, a median of 23 cases/institution. The indications for treatment were chronic or therapy refractory pain. The total dose ranged between 2.5 and 18.75 Gy (median 6), and single fractions ranged between 0.3 and 1. 5 Gy (median 1). Of the responding institutions, 44.9% applied two fractions and 37.5% three fractions weekly. RT was delivered with orthovoltage units (38.2%), linear accelerators (53.7%), (60)Co units (5.1%), or other treatment units (3%). Seventy-six institutions presented their retrospective clinical evaluation in a total of 7947 patients. Pain reduction for at least 3 months was reported in 70%, and persistent pain reduction was reported in 65% of the treated patients. In 19 institutions, a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed.
The study comprised the largest number of cases reported of RT for painful HSS. Despite variations in the daily RT practice, this national patterns of care study represents a very large number of painful and refractory HSS cases that were treated effectively with RT.
在一项护理模式的总体研究之后，德国良性疾病放射治疗合作组开展了一项多中心队列研究，以分析疼痛性跟骨骨刺综合征（HSS）的放射治疗（RT）。
2001年，在德国所有放射治疗机构使用标准化结构化问卷开展了一项护理模式研究。评估了患者入组情况、患者数量、预处理、疼痛记录、治疗指征、放射治疗技术以及疼痛性HSS的靶区体积概念。此外，还评估了功能和主观结果。
146家机构（79.3%）返回了问卷：10家（6.8%）报告没有HSS放射治疗的临床经验，136家（93.2%）每年治疗3621例患者，每家机构中位数为23例。治疗指征为慢性或治疗难治性疼痛。总剂量在2.5至18.75 Gy之间（中位数6 Gy），单次剂量在0.3至1.5 Gy之间（中位数1 Gy）。在回复的机构中，44.9%采用每周两次分割，37.5%采用每周三次分割。放射治疗使用正交电压装置（38.2%）、直线加速器（53.7%）、（60）钴装置（5.1%）或其他治疗装置（3%）。76家机构对总共7947例患者进行了回顾性临床评估。70%的治疗患者报告疼痛减轻至少3个月，65%的患者报告疼痛持续减轻。19家机构因疼痛反应不足或早期疼痛复发而进行了第二次放射治疗系列。未观察到放射性急性或慢性副作用。
该研究纳入了已报告的疼痛性HSS放射治疗病例数最多的研究。尽管放射治疗的日常实践存在差异，但这项全国性护理模式研究代表了大量疼痛性和难治性HSS病例，这些病例通过放射治疗得到了有效治疗。
