足跟痛、跟腱痛、膝关节痛、转子滑囊炎和肩部疼痛综合征的放射治疗-前瞻性临床质量评估的早期和晚期结果。
Radiotherapy for calcaneodynia, achillodynia, painful gonarthrosis, bursitis trochanterica, and painful shoulder syndrome - Early and late results of a prospective clinical quality assessment.
机构信息
Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Kiskerstrasse 26, D-33615, Bielefeld, Germany.
Department of Internal Medicine, St. Anna Hospital, Herne, Germany.
出版信息
Radiat Oncol. 2018 Apr 19;13(1):71. doi: 10.1186/s13014-018-1025-y.
BACKGROUND
The aim of this prospective clinical quality assessment was to evaluate the short-term and long-term efficacy of low dose radiotherapy (RT) for calcaneodynia, achillodynia, painful gonarthrosis, painful bursitis trochanterica, and painful shoulder syndrome.
METHODS
Between October 2011 and October 2013, patients with calcaneodynia, achillodynia, painful gonarthrosis, painful bursitis trochanterica, and painful shoulder syndrome were recruited for this prospective clinical quality assessment. Single doses of 0.5-1.0 Gy and a total dose of 6.0 Gy per series were used. Pain was measured before and directly after RT (early response) with a visual analogue scale (VAS). Additionally, pain relief was measured with the four-scale pain score according to "von Pannewitz" (VPS) immediately at the end of RT and during follow-up. Within this context we defined a good response as complete pain relief and markedly improved. The assessment of the long-term efficacy was carried out by a telephone survey.
RESULTS
703 evaluable patients (461 female, 242 male) with a mean age of 63.2 years (28-96) were recruited for this prospective clinical quality assessment. In 254 patients RT was performed with the linear accelerator, 449 patients received orthovoltage radiotherapy. After a median follow-up of 33 months (3-60) 437 patients could be reached for evaluation of follow up results. The mean VAS value before treatment was 6.63 (1.9-10) and immediately on completion of RT 4.51 (0-10) (p < 0,001). Concerning the VPS immediately on completion of RT, a good response could be achieved in 264/703 patients (37.6%), and with the follow up in 255/437 patients (58.4%) (p < 0.001). Only in patients with gonarthrosis we could not observe a significantly improved long-term success in comparison to the results immediately after RT (30.2% versus 29.9%).
CONCLUSION
Low dose RT is a very effective treatment for the management of calcaneodynia, achillodynia, painful gonarthrosis, painful bursitis trochanterica, and painful shoulder syndrome. Due to the delayed onset of analgesic effects low dose RT results in a significantly improved long-term efficacy in comparison to the results immediately after RT particularly in patients with calcaneodynia, achillodynia, bursitis trochanterica, and shoulder syndrome.
背景
本前瞻性临床质量评估的目的是评估低剂量放射治疗（RT）治疗跟痛症、跟腱痛、疼痛性膝关节骨关节炎、疼痛性转子滑囊炎和肩部疼痛综合征的短期和长期疗效。
方法
2011 年 10 月至 2013 年 10 月，招募了患有跟痛症、跟腱痛、疼痛性膝关节骨关节炎、疼痛性转子滑囊炎和肩部疼痛综合征的患者参加这项前瞻性临床质量评估。使用单次剂量 0.5-1.0Gy 和每个系列 6.0Gy 的总剂量。使用视觉模拟量表（VAS）在 RT 前后（早期反应）测量疼痛。此外，根据“冯·帕内维茨”（von Pannewitz）的四尺度疼痛评分（VPS）在 RT 结束时和随访期间立即测量疼痛缓解情况。在此背景下，我们将完全缓解疼痛和明显改善定义为良好反应。通过电话调查评估长期疗效。
结果
这项前瞻性临床质量评估共招募了 703 例可评估患者（461 例女性，242 例男性），平均年龄 63.2 岁（28-96 岁）。254 例患者使用线性加速器进行 RT，449 例患者接受正交照射放疗。中位随访 33 个月（3-60 个月）后，有 437 例患者可进行随访结果评估。治疗前 VAS 平均值为 6.63（1.9-10），RT 结束时立即为 4.51（0-10）（p<0.001）。关于 RT 结束时的 VPS，703 例患者中有 264/703 例（37.6%）获得良好反应，437 例患者中有 255/437 例（58.4%）在随访时获得良好反应（p<0.001）。只有在膝关节骨关节炎患者中，我们没有观察到与 RT 后即刻相比，长期疗效显著改善（30.2%与 29.9%）。
结论
低剂量 RT 是治疗跟痛症、跟腱痛、疼痛性膝关节骨关节炎、疼痛性转子滑囊炎和肩部疼痛综合征的非常有效的治疗方法。由于镇痛效果延迟，与 RT 后即刻相比，低剂量 RT 可显著提高长期疗效，尤其是在跟痛症、跟腱痛、转子滑囊炎和肩部疼痛综合征患者中。
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