November 12, 2024 – Low-dose radiation therapy (LDRT) has been shown to have a strong anti-inflammatory effect within the body and has been used to treat painful musculoskeletal disorders around the world for decades. Recently, there has been a surging interest in the United States to use LDRT for the treatment of osteoarthritis and other benign indications, such as Dupuytren’s Contracture, Ledderhose disease, keloids and plantar fasciitis.
Notably, LDRT was a hot topic at the 2024 American Society for Radiation Oncology (ASTRO) Annual Meeting. The meeting featured a major panel discussion (chair – Dr. Simul Parikh, Lake Huron Medial Center), in addition to presentations by LDRT practitioners, including FHN/Leonard Ferguson Cancer Center’s Dr. Bobby Koneru, UC San Diego Health’s Dr. Jona Hattangadi-Gluth, and Northside Hospital’s Dr. Mudit Chowdhary. This track was part of the Practical Radiation Oncology (PRO) Program, and a recording of the presentation is available for ASTRO members to view by logging into their ASTRO account.
Dr. Chowdhary and the team at Northside Hospital (Atlanta, Georgia) use LDRT to treat Dupuytren’s Contracture, Ledderhose disease, and osteoarthritis. “LDRT is the most effective treatment for early stage Dupuytren’s Contracture – when there are nodules on the palm and before there is curvature of fingers,” states Dr. Chowdhary. They use a mask for immobilizing the patient treatment area. These masks fit on any baseplate so that they can plug-and-play with other equipment from immobilization vendors. He adds: “Masks are used to ensure consistent positioning, with the treatment planning and precision-driven treatment delivery in Eclipse™.”
“LDRT is the most effective treatment for early stage Dupuytren’s Contracture – when there are nodules on the palm and before there is curvature of fingers. Masks are used to ensure consistent positioning, with the treatment planning and precision-driven treatment delivery in Eclipse.” – Mudit Chowdhary, Radiation Oncologist, Northside Hospital
Dr. Chowdhary uses LDRT to treat Ledderhose disease just as effectively as Dupuytren’s. Ledderhose disease is often referred to as Dupuytren’s of the foot. In 2023, the LedRad Phase 3 randomized controlled trial demonstrated greater pain reduction and improvement in quality of life for patients treated with radiotherapy vs those who did not receive it. Both Dupuytren’s and Ledderhose are treated in two separate courses of 5 daily fractions sandwiched around a 10-week break. LDRT can be used on multiple nodules at once with limited side effects, and it can halt or cause regression of the nodules.
LDRT for osteoarthritis (3 Gy in 6 fractions) is being increasingly utilized across the country. On average, 70% of patients note improvement in their pain symptoms following LDRT. For non-responders, a second round of LDRT can be administered to the same joint 3 months later. Orfit masks are used at the City of Hope Hospital (Duarte, California), where they use LDRT to treat osteoarthritis, skin conditions such as T-cell lymphoma, and other benign diseases of the joints. Razmig Zovigian, R.T. (R)(CT)(MR)(T), Lead Technical Radiation Therapist at City of Hope, explains that they use the Orfit extremities board and masks to immobilize hands, ankles and toes to treat osteoarthritis.
“You can use the Orfit mask any way you want to – there’s an infinite way to use them,” Zovigian said. “We use them for hands, toes, ankles, knees – anything it is needed for, you just need to be creative. They are reproducible, and we can treat osteoarthritis using a total dose of 3 Gy delivered over 6 fractions.” – Razmig Zovigian, Lead Technical Radiation Therapist, City of Hope
Image from City Of Hope: Osteoarthritis – hand. The total dose is 3 Gy delivered in 6 fractions.
LDRT for benign conditions is gaining popularity due to its effective, non-invasive nature and favorable safety profile. Increased evidence supporting its benefits, in addition to expanding reimbursement options, makes it an attractive treatment choice. More centers should seriously explore this approach to enhance patient care and broaden treatment possibilities for various conditions.
Reference:
About Mudit Chowdhary: https://nroc-ga.com/providers/mudit-chowdhary
Learn more about the LedRad study here: https://pubmed.ncbi.nlm.nih.gov/37211283/
Learn more about Razmig Zovigian and the use of Orfit Extremities solution at City of Hope: https://www.orfit.com/the-orfit-extremities-solution-webcast
The English version 3.0 of the German Guidelines for Radiotherapy of Benign Diseases containing a large chapter on Dupuytren & Ledderhose Disease (pages 60 – 78) +is now available for download free of any fees on the DEGRO homepage of the German RadioOncological Society.
LINK:
(1) GoTo: https://lnkd.in/gcwruZZe
(2) Access 1st Line:
S-2 Guideline – Radiotherapy of Benign Diseases – English Version (November 2022)
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