title: Low-dose external beam radiotherapy for greater trochanteric pain syndrome : Target volume definition and treatment outcome.
abstract: OBJECTIVE
  Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives.
  
  
  METHODS
  In all, 60 patients (74 hips) received LD-EBRT (6 × 0.5 Gy in 29 hips, 6 × 1 Gy in 45). The endpoint was the patient's reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated.
  
  
  RESULTS
  At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis "inclusion of the total femoral head into the PTV" and "night pain before LD-EBRT" were correlated with symptom remission at the end of LD-EBRT, while "initial increase in pain during LD-EBRT" was significantly associated with treatment failure. In multivariable modeling "initial increase in pain" was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048-0.957), while "night pain" was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004-12.6). Three months after LD-EBRT "night pain" and "inclusion of the complete femoral neck circumference into the PTV" were predictive for remission.
  
  
  CONCLUSIONS
  LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed.
authors.affiliation: Department of Orthopedic and Trauma 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.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaltenborn
authors.affiliation: Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede, Germany.
authors.forename: Ulrich Martin
authors.initials: UM
authors.lastname: Carl
authors.affiliation: Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Hinsche
authors.affiliation: Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede, Germany.|Department of Radiotherapy, Karl-Lennert Cancer Center, University of Schleswig Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Nitsche
authors.affiliation: Center for Radiotherapy and Radiooncology Bremen and Westerstede, Westerstede, Germany. hermann@strahlentherapie-westerstede.com.|Department of Radiotherapy and Special Oncology, Hannover Medical School, Hannover, Germany. hermann@strahlentherapie-westerstede.com.
authors.forename: Robert Michael
authors.initials: RM
authors.lastname: Hermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis* / Q000532:radiotherapy*; D005260:Female; D005269:Femur / Q000528:radiation effects; D006621:Hip Joint / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000528:radiation effects*; D000069079:Radiation Exposure / Q000032:analysis*; D011879:Radiotherapy Dosage; D013577:Syndrome; D016896:Treatment Outcome
keywords: Bursae; Bursitis trochanterica; Greater trochanteric pain syndrome; Low-dose radiotherapy; Target volume definition