Radiation therapy for benign diseases
The radiotherapy for benign disease or medical radiotherapy in non- malignant disease is a form of radiation therapy , a medical application of ionizing radiation (X-rays and gamma rays) to treat benign (= non-malignant) diseases, mostly of wear and tear and inflammation of the joints. Synonymous with the designations (X-ray) radiation stimulus, (X-ray) low radiation (X-ray) depth therapy and inflammation radiation needed.
history
As early as 1896, one year after its discovery, the Viennese dermatologist Leopold Freund used X-rays for the first time to treat patients. He successfully irradiated the hairy nevus of a teenager. In 1897, Hermann Gocht published radiation treatment for trigeminal neuralgia , and Alexei Petrowitsch Sokolow (1854–1928) wrote about radiotherapy for joint inflammation in the progress in the field of X-rays (RöFo) . The Freiburg radiologist Günther von Pannewitz (1900–1966) perfected what he called X - ray stimulation for degenerative diseases in the 1930s. With the increasing spread of more powerful X-ray tubes and telecobalt devices, the therapies of deeper body layers could be approached. There was temporarily a wide range of benign diseases that were irradiated: eczema , suppuration, rheumatism , keloids , fistulas and many others. This expansion of the method, which in retrospect was too uncritical, resulted in side effects, above all in a worrying accumulation of cancer among the often young people affected. In 1959, the British health authorities published a report showing an alarming increase in the rate of leukemia among patients who had received radiation therapy for the spinal column for ankylosing spondylitis . As a result, radiation therapy for benign diseases was almost completely discontinued in the Western European countries. In the Eastern European countries, which were less well supplied with drugs such as anti-inflammatory drugs, it lost less ground. Efforts are now being made to re-establish the method with a limited range of indications and only in older patients. At present around 40,000 radiation therapies for benign diseases are carried out in Germany every year.
Mode of action
In animal experiments, the low-dose radiation therapy had effects on the cellular immune response ( apoptosis of lymphocytes, reduced activity of inflammatory activated macrophages and endothelial cells ). From around 12 Gy the activity of fibroblasts was slowed down, which could explain the inhibition of excessive scarring. Radiation given shortly before or after an operation also inhibited the differentiation of mesenchymal stem cells into osteoblasts ; this can prevent pathological ossification in the wound area. So far, almost exclusively retrospective data have been collected on humans; Current controlled-randomized studies are not available and are hardly to be expected given the overall low number of sick people in individual facilities. After all, recent studies often work with objectifiable scores in addition to the simple self-assessment of those affected. The success rate in the available studies fluctuates between 50% and 80%; the best results were obtained with treatment of the shoulder, elbow and heel spur.
Indications and dosages
According to current textbooks, the following benign diseases are accessible to radiation therapy, whereby the success rates and risks of competing procedures ( non-steroidal anti-inflammatory drugs , glucocorticoids , operations ) must be weighed up:
- Acute inflammation ( boils , hidradenitis , foot rot , paronychia , eczema , psoriasis ) can be treated with very low total doses (0.5-2 Gy);
- Chronic inflammation (insertion tendinopathies such as periarthritis humeroscapularis on the shoulder, epicondylopathia humeri on the elbow, plantar fasciitis in the heel spur on the foot, activated osteoarthritis , endocrine orbitopathy ) require somewhat higher dosages, about 3–6 Gy;
- Benign growths ( Dupuytren's disease , plantar fibromatosis , Peyronie's disease , keloids , ossification , pterygium ) must be preventively irradiated at an early stage or, usually with 12 to 24 Gy.
- At times there were devices for irradiating the coronary arteries after vasodilating surgery in order to prevent the formation of scar tissue. Newly developed stents have made this indication obsolete in recent years.
For comparison: radiation therapy for cancer diseases usually uses at least 45 to 70 Gy when conventionally divided into small individual doses.
Current treatment principles require an interdisciplinary indication (i.e. together with orthopedic and surgical specialists), a risk-benefit analysis and corresponding information for those affected, exhaustion of radiation protection measures and dose calculation and documentation in accordance with the applicable regulations ( ICRU -50, StrSchVO ). Linear accelerators are mostly used; if available, the older X-ray facilities for radiation therapy. The sick should be examined for at least six months as part of the radiation therapy.
Risks
As with all radiation therapies, the risk depends very much on the exact location and arrangement of the radiation fields and on the age. Under certain circumstances, ionizing radiation used for therapy can cause so-called secondary tumors. The main organs at risk for this are the thyroid gland , the female breast , the gonads and the bone marrow . If these organs are spared and the therapy is limited to patients over 45 years of age, the risk remains in the order of 1: 10,000. In practice, functional disorders of organs that are particularly sensitive to radiation are more relevant than carcinogenesis ( carcinogenesis ): the heart , gonads, lens of the eye and child growth plates on the skeleton may only be loaded with very small doses in order to reliably prevent damage.
literature
- Michael Heinrich Seegenschmiedt, Hans-Bruno Makoski, Klaus-Rüdiger Trott, Luther W. Brady (Eds.): Radiotherapy for Non-Malignant Disorders. Contemporary Concepts and Clinical Results. Springer, Berlin / Heidelberg 2007, ISBN 978-3-540-62550-6 .
- Stanley E. Order, Sarah S. Donaldson: Radiation Therapy of Benign Diseases. A clinical guide. Springer, Berlin / Heidelberg 2003, ISBN 3-540-00575-7 .
Individual evidence
- ↑ Peter G. Smith : The 1957 MRC report on leukaemia and aplastic anemia in patients irradiated for ankylosing spondylitis. In: J. Radiol. Prot. 27, 4B, Dec. 2007, pp. B3-B14. doi: 10.1088 / 0952-4746 / 27 / 4B / R01
- ↑ Michael Heinrich Seegenschmiedt, Oliver Micke, Norman Willich, German Cooperative Group on Benign Diseases (GCG-BD): Radiation therapy for nonmalignant diseases in Germany. Current concepts and future perspectives. In: Strahlenther Onkol . 180, Nov. 11, 2004, pp. 718-730. doi: 10.1007 / s00066-004-9197-9 , PMID 15549190
- ↑ Peter Köhler: Radiation Therapy for Non-Malignant Diseases ( Memento of the original of August 10, 2007 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . (PDF; 223 kB). Hansjörg Zwicker & Partner, Constance 2007.
