Rev. Soc. Esp. Dolor. 2024; 31(3): 157-164 / DOI: 10.20986/resed.2025.4105/2023
Elena Oliver, Elena Cañadillas, Jacobo Yáñez, Cilia Peralta, Pilar del Río, Eva Palero
ABSTRACT
Introduction: Osteoarthritis (OA) is a degenerative disease that causes painful conditions with significant functional limitation. Currently, the therapeutic success rate of conservative treatment of OA can be improved, which favors the interest in finding new effective therapies for its management. Low-dose radiotherapy (LD-RT) has been used for years to alleviate the symptoms of OA; however, in many countries this therapy is not widely used due to the absence of a solid scientific basis. Recently, several articles have been published with promising results supported by some scientific evidence thanks to randomized and controlled designs.
Our objective is to describe the results of these recently published investigations, which have analyzed the effectiveness, safety and pathogenic basis of RT-DB.
Methods: A systematic search of the published literature was performed in Pubmed, Embase and Cochrane databases. To describe efficacy, only RCTs and prospective OEs were selected.
Results: The anti-inflammatory and osteoforming power of RT-DB was observed in a total of 6 investigations. To evaluate efficacy, 10 studies were included, all of which showed positive results, except for two RCTs that found no differences with respect to placebo. Regarding the safety of this therapy, the association of immediate serious adverse events seems to be ruled out.
Conclusions: The latest research seems to support the hypothesis that RT-DB may be effective in mitigating the clinical impact of OA, which seems to be based on its anti-inflammatory effect at the cartilage level. However, although the large influx of RCTs compared to previous decades is indisputable, there is still a need to improve the methodological design of new research, mainly through larger sample sizes, multicenter participation and comparison with other available therapies.
RESUMEN
Introducción: La artrosis (OA) es una enfermedad degenerativa que ocasiona cuadros dolorosos con importante limitación funcional. Actualmente, la tasa de éxito terapéutico del tratamiento conservador de la OA es altamente mejorable, lo que favorece el interés por encontrar nuevas terapias eficaces para su manejo. La radioterapia a dosis bajas (RT-DB) se ha utilizado desde hace años para aliviar los síntomas de la OA, sin embargo, en muchos países no se ha extendido su uso debido a la ausencia de una base científica consolidada que apoye su eficacia. Recientemente, se han publicado varios artículos con resultados prometedores respaldados por cierta evidencia científica gracias a diseños aleatorizados y controlados.
Nuestro objetivo es describir los resultados de estas investigaciones, que han analizado la eficacia, seguridad y base patogénica de la RT-DB.
Método: Se realizó una búsqueda sistemática de la literatura publicada en las bases de datos PubMed, Embase y Cochrane. Para describir la eficacia, únicamente se seleccionaron ECA y EO prospectivos.
Resultados: Se observó el poder antinflamatorio y osteoformador de la RT-DB en un total de 6 investigaciones experimentales. Para evaluar la eficacia se incluyeron 10 estudios, que mostraron resultados positivos, salvo dos ECA que no encontraron diferencias respecto a placebo. En cuanto a la seguridad de esta terapia, parece descartarse la asociación de eventos adversos graves inmediatos.
Conclusiones: Las últimas investigaciones parecen apoyar la hipótesis de que la RT-DB puede resultar eficaz para mitigar la repercusión clínica de la OA, lo cual parece fundamentarse en su efecto antinflamatorio a nivel del cartílago. Sin embargo, aunque es indiscutible la gran afluencia de ECA en comparación con décadas anteriores, persiste la necesidad de mejorar el diseño metodológico de nuevas investigaciones que se lleven a cabo, fundamentalmente a través de muestras de mayor tamaño, participación multicéntrica y comparación con otras terapias disponibles.
Nuevo comentario
Comentarios
No comments in this article
Bibliografía
1. Blanco FJ, Silva-Díaz M, Quevedo Vila V, Seoane-Mato D, Pérez Ruiz F, Juan-Mas A, et al. Prevalence of symptomatic osteoarthritis in Spain: EPISER2016 study Reumatol Clínica Engl Ed. 2020; 17(8):461-70.
2. Vidal Fuentes, J. Artrosis y dolor: la complejidad e impacto de un síntoma. Rev Soc Esp Dolor. 2021;28(Supl.1):1-3. DOI: 10.20986/resed.2021.3886/2021.
3. Mayoral Rojals V. Epidemiología, repercusión clínica y objetivos terapéuticos. Rev Soc Esp Dolor. 2021;28(Supl. 1):4-10. DOI: 10.20986/resed.2021.3874/2020.
4. Rodriguez-Veiga D, González-Martín C, Pertega-Díaz S, Seoane-Pillado T, Barreiro-Quintás M, Balboa-Barreiro V. Prevalencia de artrosis de rodilla en una muestra aleatoria poblacional en personas de más de 40 años de edad. Gac Med Mex; 2019;155(1):39-45. DOI: 10.24875/GMM.18004527.
5. Villar Inarejos MJ, Madrona Marcos F, Tárraga Marcos L, Romero de Ávila M, Tárraga-López J. Evaluación de los tratamientos del dolor crónico en artrosis. JONNPR. 2021;6(8):997-1033. DOI: 10.19230/jonnpr.3998.
6. Dove APH, Cmelak A, Darrow K, McComas KN, Chowdhary M, Beckta J, et al. The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review. Int J Radiat Oncol Biol Phys. 2022;114(2):203-20.
7. Donaubauer AJ, Zhou JG, Ott OJ, Putz F, Fietkau R, Keilholz L, et al. Low Dose Radiation Therapy, particularly with 0.5 Gy, Improves Pain in Degenerative Joint Disease of the Fingers: Results of a Retrospective Analysis. Int J Mol Sci. 2020;21(16):5854.
8. Koc BB, Schotanus MGM, Borghans R, Jong B, Maassen ME, Buijsen J, et al. Short-term pain reduction after low-dose radiotherapy in patients with severe osteoarthritis of the hip or knee joint: a cohort study and literature review. Eur J Orthop Surg Traumatol. 2019;29(4):843-7.
9. Mahler EAM, Minten MJ, Leseman-Hoogenboom MM, Poortmans PMP, Leer JWH, Boks SS, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. Ann Rheum Dis. 2019;78(1):83-90.
10. Javadinia SA, Nazeminezhad N, Ghahramani-Asl R, Soroosh D, Fazilat-Panah D, PeyroShabany B, et al. Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data. Int J Radiat Biol. 2021;97(10):1352-67.
11. Montero A, Sabater S, Rödel F, Gaipl US, Ott OJ, Seegenschmiedt MH, et al. Is it time to redefine the role of low-dose radiotherapy for benign disease? Ann Rheum Dis. 2020;79(3):e34.
12. Voos P, Fuck S, Weipert F, Babel L, Tandl D, Meckel T, et al. Ionizing Radiation Induces Morphological Changes and Immunological Modulation of Jurkat Cells. Front Immunol. 2018;9:922.
13. Lumniczky K, Impens N, Armengol G, Candéias S, Georgakilas AG, Hornhardt S, Martin OA, Rödel F, Schaue D. Low dose ionizing radiation effects on the immune system. Environ Int. 2021;149:106212.
14. Falcke SE, Rühle PF, Deloch L, Fietkau R, Frey B, Gaipl US. Clinically Relevant Radiation Exposure Differentially Impacts Forms of Cell Death in Human Cells of the Innate and Adaptive Immune System. Int J Mol Sci. 2018;19(11):3574.
15. Kim BH, Bae HC, Wang SY, Jang BS, Chang JH, Chie EK, et al. Low-dose irradiation could mitigate osteoarthritis progression via anti-inflammatory action that modulates mitochondrial function. Radiother Oncol. 2022;170:231-41.
16. Deloch L, Derer A, Hueber AJ, Herrmann M, Schett GA, Wölfelschneider J, et al. Low-Dose Radiotherapy Ameliorates Advanced Arthritis in hTNF-α tg Mice by Particularly Positively Impacting on Bone Metabolism. Front Immunol. 2018;9:1834.
17. Deloch L, Fuchs J, Rückert M, Fietkau R, Frey B, Gaipl US. Low-Dose Irradiation Differentially Impacts Macrophage Phenotype in Dependence of Fibroblast-Like Synoviocytes and Radiation Dose. J Immunol Res. 2019;2019:3161750.
18. Minten MJM, Leseman-Hoogenboom MM, Kloppenburg M, Kortekaas MC, Leer JW, Poortmans PMP, et al. Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis Cartilage. 2018;26(10):1283-90.
19. Kaltenborn A, Bulling E, Nitsche M, Carl UM, Hermann RM. The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis: Importance of field size. Strahlenther Onkol. 2016;192(8):582-8.
20. Rogers S, Eberle B, Vogt DR, Meier E, Moser L, Gomez Ordoñez S, et al. Prospective Evaluation of Changes in Pain Levels, Quality of Life and Functionality After Low Dose Radiotherapy for Epicondylitis, Plantar Fasciitis, and Finger Osteoarthritis. Front Med (Lausanne). 2020;7:195.
21. Hermann RM, Trillmann A, Becker JN, Kaltenborn A, Nitsche M, Ruettermann M. Prospective Evaluation of Low-Dose External Beam Radiotherapy (LD-EBRT) for Painful Trapeziometacarpal Osteoarthritis (Rhizarthrosis) on Pain, Function, and Quality of Life to Calculate the Required Number of Patients for a Prospective Randomized Study. Med Sci (Basel). 2021;9(4):66.
22. Álvarez B, Montero A, Alonso R, Valero J, López M, Ciérvide R, et al. Low-dose radiation therapy for hand osteoarthritis: shaking hands again? Clin Transl Oncol. 2022;24(3):532-9.
23. Micke O, Seegenschmiedt MH, Adamietz IA, Kundt G, Fakhrian K, Schaefer U, et al. Low-Dose Radiation Therapy for Benign Painful Skeletal Disorders: The Typical Treatment for the Elderly Patient? Int J Radiat Oncol Biol Phys. 2017;98(4):958-63.
24. Mahler EAM, Minten MJ, Leseman-Hoogenboom MM, Poortmans PMP, Leer JWH, Boks SS, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. Ann Rheum Dis. 2019;78(1):83-90.
25. Koc BB, Schotanus MGM, Borghans R, Jong B, Maassen ME, Buijsen J, et al. Short-term pain reduction after low-dose radiotherapy in patients with severe osteoarthritis of the hip or knee joint: a cohort study and literature review. Eur J Orthop Surg Traumatol. 2019;29(4):843-7.
26. Niewald M, Müller LN, Hautmann MG, Dzierma Y, Melchior P, Gräber S, et al. ArthroRad trial: multicentric prospective and randomized single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis depending on the dose-results after 3 months' follow-up. Strahlenther Onkol. 2022;198(4):370-7.
27. Donaubauer AJ, Becker I, Weissmann T, Fröhlich BM, Muñoz LE, Gryc T, et al. Low Dose Radiation Therapy Induces Long-Lasting Reduction of Pain and Immune Modulations in the Peripheral Blood - Interim Analysis of the IMMO-LDRT01 Trial. Front Immunol. 2021;12:740742.
28. Huang Z, Chen J, Ma J, Shen B, Pei F, Kraus VB. Effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23(9):1437-44.
29. Minten MJ, Mahler E, den Broeder AA, Leer JW, van den Ende CH. The efficacy and safety of low-dose radiotherapy on pain and functioning in patients with osteoarthritis: a systematic review. Rheumatol Int. 2016;36(1):133-42.
30. Abdus-Salam AA, Olabumuyi AA, Jimoh MA, Folorunso SA, Orekoya AA. The role of radiation treatment in the management of inflammatory musculoskeletal conditions: a revisit. Radiat Oncol J. 2020;38(3):151-61.
31. Javadinia SA, Nazeminezhad N, Ghahramani-Asl R, Soroosh D, et al. Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data. Int J Radiat Biol. 2021;97(10):1352-67.
32. Dove APH, Cmelak A, Darrow K, McComas KN, Chowdhary M, Beckta J, et al. The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review. Int J Radiat Oncol Biol Phys. 2022;114(2):203-20.
33. Keller S, Müller K, Kortmann RD, Wolf U, Hildebrandt G, Liebmann A, et al. Efficacy of low-dose radiotherapy in painful gonarthritis: experiences from a retrospective East German bicenter study. Radiat Oncol. 2013;8:29.
34. Juniku N, Micke O, Seegenschmiedt MH, Muecke R. Radiotherapy for painful benign skeletal disorders: Results of a retrospective clinical quality assessment. Strahlenther Onkol. 2019;195(12):1068-73.
35. Abdelmaqsoud A, Vorotniak N, Strauß D, Hentschel B. The analgesic effect of low-dose radiotherapy in treating benign musculoskeletal painful disorders using different energies: A retrospective cohort study. J Radiother Pract. 2023;22:E78.
36. Aramburu F, Montero A, Cabrera Alarcón JL, García de la Peña-Lefevre P. Tratamiento con radioterapia en enfermedad osteoarticular benigna. Reumatol Clin. 2021;17(10):624-5.
37. Aramburu F, Montero A, Silvia R, González J, Calvo E, Valero M, et al. Evaluation of effectivity of radiotherapy for pain control in osteoarthritis and soft tissue pathology. Annals of the Rheumatic Diseases 2017;76:1338.
38. Rühle A, Tkotsch E, Mravlag R, Haehl E, Spohn SKB, Zamboglou C, et al. Low-dose radiotherapy for painful osteoarthritis of the elderly: A multicenter analysis of 970 patients with 1185 treated sites. Strahlenther Onkol. 2021;197(10):895-902.
39. Rivas D, Hernández R. Radiotherapy 3 vs 6 Gy in Gonarthrosis and Coxarthrosis (RAGOCO) [Internet]. GPC NETWORK; 19 de enero de 2020. Disponible en: https://ichgcp.net/clinical-trials-registry/NCT04424628