Low-dose radiotherapy for painful osteoarthritis of the elderly: A\xa0multicenter analysis of 970\xa0patients with 1185 treated sites

Alexander Rühle,Anca-Ligia Grosu,Peter E Huber,Constantinos Zamboglou,Jürgen Debus,Erik Haehl,Tanja Sprave,Elisabeth Tkotsch,Simon K B Spohn,Nils H Nicolay,Rainer Mravlag

doi:10.1007/s00066-021-01816-y

Abstract

PurposePainful osteoarthritis is common in elderly patients, and low-dose radiotherapy has been demonstrated to provide effective symptomatic treatment. We examined the analgesic effects of low-dose radiotherapy for osteoarthritis in the elderly aiming to reveal potential differences in the response rates relating to increasing age.MethodsA retrospective analysis was performed at two university hospitals including elderly patients (≥ 65 years) undergoing radiotherapy for osteoarthritis between 2008 and 2020. Pain intensity and response were quantified using the numerical rating scale (NRS) and the Pannewitz score. Age groups were defined for young old (65–74 years), older old (75–84 years), and oldest old patients (≥ 85 years).ResultsIn all, 970 patients with 1185 treated sites and a median age of 76 years were analyzed. Mean NRS was 66 at baseline (t0), 53 after radiotherapy (t1), and 44 at first follow-up (t2) (p < 0.001 for t0–t1, t1–t2, and t0–t2). At t1, 1.5% exhibited a Pannewitz score of 0 (no pain), 58.5% of 1–2 (less pain), 36.1% of 3 (equal pain), and 3.9% of 4 (worse pain), while at t2, pain response shifted towards 6.9% (0), 58.6% (1–2), 28.1% (3), and 6.3% (4). Pain response did not differ between age groups at t1 (p = 0.172) or t2 (p = 0.684). In addition, pain response after re-irradiation (n = 384 sites) was 61.0% and was comparable between age groups (p = 0.535).ConclusionLow-dose radiotherapy results in pain reduction in about two-thirds of treated sites with no difference relating to increasing age, showing that radiotherapy is an effective analgesic treatment for osteoarthritis even at advanced ages.

Highlights

Osteoarthritis is a common disease especially in the elderly that is becoming more frequent in developed countries due to an increasing life expectancy [1]
The majority of patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) prior to radiotherapy (n = 733, 61.9%), and a considerable percentage of patients had received prior intraarticular corticosteroid injections (n = 221, 18.6%)
We demonstrated in a large multicenter cohort including 970 elderly patients with 1185 treated sites that low-dose radiotherapy is an analgesic treatment for painful osteoarthritis irrespectively of patient age

Summary

Introduction

Osteoarthritis is a common disease especially in the elderly that is becoming more frequent in developed countries due to an increasing life expectancy [1]. Considering the reduction of health-related quality-of-life in affected patients, the considerable socioeconomic costs due to multiple therapeutic procedures, and the secondary complications, e.g., opioid abuse, psychological disorders, physical inactivity and thereby increased risk for obesity and cardiovascular diseases, osteoarthritis has a huge impact on the health systems [4,5,6,7]. Due to the anti-inflammatory effects of small doses of ionizing radiation, low-dose radiotherapy is commonly used in patients with painful osteoarthritis, especially in central and Eastern Europe [9]. Lowdose radiotherapy was found to positively influence bone metabolism by increasing osteoblast-induced mineralization and decreasing RANK-L levels [17]

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Discussion

Conclusion