Radiotherapy for calcaneodynia
- PDF / 569,074 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 55 Downloads / 175 Views
· C. Jeremias · U.S. Gaipl · B. Frey · M. Schmidt · R. Fietkau Department of Radiation Oncology, University Hospital Erlangen
Radiotherapy for calcaneodynia Results of a single center prospective randomized dose optimization trial
Calcaneodynia commonly causes inferior heel pain and occurs in up to 10% of the population [4]. The condition affects active and sedentary adults of all ages. Plantar fasciitis is more likely to occur in obese people, who spend most of the day on their feet. Experts believe that the pain is mainly caused by acute or chronic injury to the origin of the plantar fascia from cumulative overload stress [1, 4]. Most interventions used to manage calcaneodynia have not been studied adequately; however, shoe inserts, stretching exercises, steroid injection, and custom-made night splints may be beneficial. Extracorporeal shock wave therapy may effectively treat a number of patients with chronic heel pain but is ineffective in others [36, 40]. Limited evidence suggests that casting or surgery may be beneficial when conservative measures fail [4]. For decades, radiotherapy has been successfully applied in the treatment of benign hyperproliferative and degenerative diseases [7, 8, 9, 18, 20] including calcaneodynia [11, 21], and encouraging results of approximately 13,000 patients had been published (see . Tab. 3). Nevertheless, an optimal radiotherapy regimen still is not clear and under current discussion [30]. Fraction doses of 0.5–1.0 Gy and total doses of 3–6 Gy are generally accepted [11, 21]. Modulations of a plethora of immunological processes by low and intermediate doses of X-ray have been identified with preclinical in vitro and in vivo model systems during recent years [26]. A discontinuous dose dependency for the
induction of an anti-inflammatory phenotype of immune cells has mostly been observed with a maximum effect in the dose range between 0.3 and 0.7 Gy [25]. The present prospective and randomized trial was initiated to determine the optimal single dose in terms of efficacy and radiation protection, as previously conducted for benign painful elbow syndrome [23].
Patients and methods Between February 2006 and April 2010, a total of 499 consecutive patients with calcaneodynia were treated at Erlangen University Hospital. Of these, 20 refused study participation and 22 patients could not be included into the analysis
because of incomplete data (. Fig. 1). At the time of radiotherapy, the median age of the remaining 457 evaluable patients was 55 years (range 27–86 years). All patients participated in our comprehensive dose optimization trial with a total of more than 1,000 patients recruited. Informed consent was obtained from all patients. Additional information on patient and treatment characteristics may be found in . Tab. 1.
Treatment All patients received radiotherapy in orthovoltage technique (Siemens Stabilipan, 250 kV, 15 mA, 1 mm Cu-filter, focus–skin distance 40 cm) usually with a
Tab. 1 Patient and treatment characteristics Cases [n/N (%)] Gender [n/N (%)] Male
Data Loading...
