Benign Diseases: Radiation Therapy

Benign conditions that can be treated with radiation therapy can be classified into different types, specifically degenerative, inflammatory, hyperproliferative, and functional conditions or dysfunctions.

Examples of this include the commonly known tennis elbow and heel spurs, as well as the resulting inflammatory condition of the sole of the foot (plantar fasciitis). These conditions can result from chronic overuse (tennis elbow), being overweight, standing for long periods, or wearing ill-fitting shoes (heel spurs). Chronic plantar fasciitis is often caused by a foot deformity (abnormal pronation of the foot). The resulting stretching of the plantar fascia leads to microtrauma, especially in the area where the fascia attaches to the heel bone (calcaneus), which ultimately contributes to the development of a heel spur.

Our primary goal is to provide you with the best possible treatment and achieve the best possible outcome. At our clinic, we regularly treat patients with benign conditions and have gained a great deal of experience in this area. We work closely and in a spirit of trust with specialists from other disciplines, such as orthopedic surgeons, rheumatologists, and ophthalmologists. In addition, we regularly exchange information with leading centers and renowned radiation oncologists in this field.

Effects of Radiation Therapy

Clinical studies have confirmed that even very low-dose radiation therapy can be an effective treatment for benign conditions (Niewald et al). Heel spurs or chronic Plantar fasciitis is treated with 3–6 therapy sessions; the radiation dose is extremely low, at 0.5–1 Gray (Gy) per session. This results in a treatment duration of approximately two weeks; if necessary, the treatment can be repeated after six weeks to achieve better results.

Studies have shown improvements in pain symptoms in approximately 85% of patients immediately after treatment and in up to 90% after six weeks (Ott et al). These results are consistent with our long-standing positive clinical experience and are all the more remarkable given that many patients come to us at a late stage and have undergone numerous previous treatments that were unsuccessful.

Because of the low dose, these radiation treatments are generally very well tolerated, and side effects are rarely expected. Below, we would like to provide you with an overview of benign conditions that we regularly treat in our daily practice and that are good candidates for radiation therapy:

Indications for Treatment

Radiation therapy is used to treat benign conditions after careful consideration of the benefits and risks, and is usually employed when other treatment options, such as medication or surgery, are not feasible. In general, very good results with excellent tolerability can be achieved using a relatively low dose.

Degenerative/inflammatory joint and soft tissue disorders

Epicondylopathy of the humerus (tennis elbow)/ Periarthropathy of the humeroscapular region (shoulder syndrome):

  • Indications for radiation therapy in cases of treatment-refractory disease
  • Low-dose radiation therapy (6 × 0.5 Gy) for pain management

Plantar fasciitis (heel spur):

  • Indications for radiation therapy after exhausting conservative treatment options
  • Low-dose radiation therapy (6 × 0.5 Gy) for pain management

Hyperproliferative Disorders

Dupuytren’s disease:

  • Indication for radiation therapy in the early stages (N/I) without significant flexion contracture
  • Low-dose radiation therapy at 10 × 2 Gy to prevent further progression

Ledderhose disease:

  • Indications for radiation therapy in clinically progressive disease at an early stage
  • Low-dose radiation therapy (10 × 2 Gy) to prevent further fibrosis

Induratio penis plastica (Peyronie’s disease):

  • Indications for Radiation Therapy for Early-Stage Soft Plaques
  • Low-dose radiation therapy (10 × 2 Gy) to prevent penile deviation

Endocrine Orbital Pathology:

  • Indications for radiation therapy during the acute phase of the disease, with or without the use of glucocorticoids
  • Standard dose: 8–10 × 2 Gy; recent data already suggest a benefit from 8 × 0.3 Gy

Risks of Radiation Therapy

After radiation therapy, there is a slightly increased risk of developing a radiation-induced ulcer. For this reason, our department generally treats patients with benign conditions with radiation therapy starting at age > 50. For patients between the ages of 30 and 50, conservative measures should be fully exhausted first (see chart).

Diagramm zur Strahlenindikation

  • Randomized, multicenter trial on the effect of radiation therapy on plantar fasciitis (painful heel spur), comparing a standard dose with a very low dose: final results after 12 months of follow-up (Niewald M, Int J Radiat Oncol Biol Phys. 2012).
  • Radiotherapy for Benign Achillodynia: Long-Term Results of the Erlangen Dose Optimization Trial (Ott et al., Strahlenther Onkol 2015)
  • Benign painful elbow syndrome. Initial results of a single-center, prospective, randomized trial on radiation therapy dose optimization (Ott et al., Strahlenther Onkol. 2012)
  • Retrobulbar irradiation for thyroid-associated orbitopathy: a double-blind comparison between 2.4 and 16 Gy. (Gerling et al., Int J Radiat Oncol Biol Phys. 2003)
  • Radiotherapy for Benign Achillodynia: Long-Term Results of the Erlangen Dose Optimization Trial (Ott et al., Strahlenther Onkol 2015)

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