The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis : Importance of field size.
The purpose of this work was to evaluate the efficacy of low-dose radiotherapy (RT) for thumb carpometacarpal osteoarthritis (rhizarthrosis). The responses of 84 patients (n = 101 joints) were analyzed 3 months after therapy (n = 65) and at 12 months (n = 27). Patients were treated with 6 fractions of 1 Gy, two times a week, with a linear accelerator. At the end of therapy, about 70 % of patients reported a response (partial remission or complete remission), 3 months later about 60 %, and 1 year after treatment 70 %. In univariate regression analysis, higher patient age and field size greater than 6 × 4 cm were associated with response to treatment, while initial increase of pain under treatment was predictive for treatment failure. Duration of RT series (more than 18 days), gender, time of symptoms before RT, stress pain or rest pain, or prior ortheses use, injections, or surgery of the joint were not associated with treatment efficacy. In multivariate regression analysis, only field size and initial pain increase were highly correlated with treatment outcome. In conclusion, RT represents a useful treatment option for patients suffering from carpometacarpal osteoarthritis. In contrast to other benign indications, a larger field size (>6 × 4 cm) seems to be more effective than smaller fields and should be evaluated in further prospective studies.
Department of Hand, Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany.|Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.
Alexander
A
Kaltenborn
Center for Radiotherapy and Radiooncology Bremen and Westerstede, Mozartstr. 30, 26655, Westerstede, Germany.
Elke
E
Bulling
Center for Radiotherapy and Radiooncology Bremen and Westerstede, Mozartstr. 30, 26655, Westerstede, Germany.|Department of Radiotherapy, Karl-Lennert Cancer Center, University of Schleswig Holstein, Campus Kiel, Kiel, Germany.
Mirko
M
Nitsche
Center for Radiotherapy and Radiooncology Bremen and Westerstede, Mozartstr. 30, 26655, Westerstede, Germany.
Ulrich Martin
UM
Carl
Center for Radiotherapy and Radiooncology Bremen and Westerstede, Mozartstr. 30, 26655, Westerstede, Germany. hermann@strahlentherapie-westerstede.com.|Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany. hermann@strahlentherapie-westerstede.com.
Robert Michael
RM
Hermann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D052737:Carpometacarpal Joints / Q000528:radiation effects*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D010003:Osteoarthritis / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal / Q000379:methods*; D012189:Retrospective Studies; D013933:Thumb / Q000528:radiation effects*; D016896:Treatment Outcome
Carpometacarpal joints; Hand; Pain; Rhizarthrosis; Treatment outcome