Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
Int J Radiat Oncol Biol Phys. 2022 Oct 1;114(2):203-220. doi: 10.1016/j.ijrobp.2022.04.029. Epub 2022 Apr 30.
Despite its clinical use and investigation in other countries, low dose radiation therapy (LDRT) in the treatment of osteoarthritis (OA) is minimally used in the United States (US). Numerous recent studies published outside the US have shown moderate to long-term pain relief and improvement of mobility after treatment with LDRT for joints affected by OA. Here, we review the most recent literature published on the use of LDRT in OA. We provide a brief outline on the epidemiology, pathophysiology, current treatments, and health care burden of OA within the US. We provide a brief history of the historic use of LDRT in the US as well as a history of LDRT within the modern era of radiation oncology, discuss criticisms of LDRT including recently published randomized trials questioning its benefit as well as the risk of secondary malignancy from LDRT, and provide an outline of treatment planning considerations and recommendations regarding dose and fractionation, energy, beam arrangements, and immobilization techniques. LDRT has been shown to be a cost-effective, noninvasive treatment with minimal side effects. Further investigation into the potential role in the treatment of OA with modern LDRT is recommended.
尽管低剂量辐射疗法 (LDRT) 在其他国家已被临床应用和研究，但在美国（US），它在治疗骨关节炎 (OA) 方面的应用却很少。最近在美国以外发表的许多研究表明，LDRT 治疗受 OA 影响的关节可在中期到长期缓解疼痛并改善活动能力。在这里，我们回顾了关于 LDRT 在 OA 中应用的最新文献。我们简要介绍了 OA 在 US 的流行病学、病理生理学、当前治疗方法和医疗保健负担。我们简要介绍了 LDRT 在 US 的历史应用，以及放射肿瘤学现代时代的 LDRT 历史，讨论了对 LDRT 的批评，包括最近发表的质疑其益处的随机试验，以及 LDRT 引发继发性恶性肿瘤的风险，并概述了治疗计划的考虑因素和建议，包括剂量和分割、能量、射束排列和固定技术。LDRT 已被证明是一种具有成本效益、非侵入性且副作用极小的治疗方法。建议进一步研究现代 LDRT 在 OA 治疗中的潜在作用。
