Rudat Volker, Tontcheva Nikoleta, Kutz Gudrun, Orovwighose Tina Ojevwe, Gebhardt Erich
MVZ Meine Strahlentherapie Nürnberg GmbH, Weiltinger Str. 11, 90449, Nuremberg, Germany.
Strahlenther Onkol. 2021 Oct;197(10):876-884. doi: 10.1007/s00066-020-01741-6. Epub 2021 Jan 27.
To estimate the long-term effect of low-dose radiotherapy of painful plantar calcaneal spurs, and to verify possible prognostic factors.
In this retrospective unicenter study, electronic patient files of patients with painful plantar calcaneal spurs treated with low-dose radiotherapy between July 2009 and February 2020 were reviewed. The low-dose radiotherapy consisted of a total dose of 3.0 Gy given with a fraction dose of 0.5 Gy three times a week. The pain reduction was estimated using a patient questionnaire with a visual analogue scale. Kaplan-Meier statistics and Cox regression analysis were used for the statistical analysis.
Altogether, 864 heels of 666 patients were reviewed. The probability of an insufficient pain control 10 years after low-dose radiotherapy was 45.9% (95% confidence interval 39.4-52.4%) in the subset of patients with a minimum follow-up of 3 months (582 heels of 467 patients). Patients with an unsatisfactory pain reduction 3 months after low-dose radiotherapy were offered a re-irradiation. Forty percent of the patients who received a re-irradiation developed good pain reduction. Occurrence of an initial aggravation of pain during or within 3 months after low-dose radiotherapy (p = 0.005), and treatment of bilateral painful plantar calcaneal spurs (p = 0.008) were identified as significant unfavorable prognostic factors on univariate analysis. On multivariate analysis, the initial aggravation of pain remained as independent significant prognostic factor (p = 0.01). No clear radiation toxicity was observed.
Low-dose radiotherapy is a safe and effective treatment option for patients with painful plantar calcaneal spurs. An initial aggravation of pain during or within 3 months after radiotherapy was identified as unfavorable prognostic factor for the treatment outcome. Re-irradiation of patients with an unsatisfactory pain reduction after low-dose radiotherapy is effective and should be offered to patients.
评估低剂量放疗对疼痛性足跟骨刺的长期疗效，并验证可能的预后因素。
在这项回顾性单中心研究中，对2009年7月至2020年2月期间接受低剂量放疗的疼痛性足跟骨刺患者的电子病历进行了回顾。低剂量放疗的总剂量为3.0 Gy，每周三次，每次分割剂量为0.5 Gy。使用带有视觉模拟量表的患者问卷评估疼痛减轻情况。采用Kaplan-Meier统计和Cox回归分析进行统计分析。
共回顾了666例患者的864只足跟。在最短随访3个月的患者亚组（467例患者的582只足跟）中，低剂量放疗10年后疼痛控制不足的概率为45.9%（95%置信区间39.4 - 52.4%）。低剂量放疗3个月后疼痛减轻不令人满意的患者接受了再次放疗。40%接受再次放疗的患者疼痛明显减轻。在单因素分析中，低剂量放疗期间或放疗后3个月内疼痛最初加重（p = 0.005）以及双侧疼痛性足跟骨刺的治疗（p = 0.008）被确定为显著的不良预后因素。在多因素分析中，疼痛最初加重仍然是独立的显著预后因素（p = 0.01）。未观察到明显的放射毒性。
低剂量放疗是疼痛性足跟骨刺患者的一种安全有效的治疗选择。放疗期间或放疗后3个月内疼痛最初加重被确定为治疗结果的不良预后因素。低剂量放疗后疼痛减轻不令人满意的患者再次放疗是有效的，应提供给患者。
