Ralph Mücke

Strahlentherapie bei schmerzhafter Kniegelenkarthrose (Gonarthrose)

BACKGROUND AND PURPOSE After a patterns-of-care study (PCS) in 2003/2004 addressing benign disorders in general, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) conducted several multicenter cohort studies including the use of radiotherapy (RT) in painful gonarthrosis (GNA). MATERIAL AND METHODS From 2006 to 2008, a PCS for GNA was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful GNA were assessed. In addition, the long-term functional and subjective outcomes were evaluated. RESULTS 238/248 institutions (95.9%) returned the questionnaire: 50 (21%) reported no clinical experience with RT in GNA, while 188 (79%) institutions treated 4,544 patients annually (median 15; range one to 846 cases per institution). Indications for treatment were acute pain symptoms in 18.9%, chronic pain in 95.3%, and treatment-refractory pain in 81.1%. The median total dose was 6 Gy (range 3-12 Gy), with a median single dose of 1 Gy (0.25-3 Gy). 40.4% of the institutions applied two fractions and 51.4% three fractions weekly. RT was delivered with orthovoltage units (25%), linear accelerators (79.6%), and cobalt-60 units (8.3%). 42 institutions evaluated the long-term clinical outcome in a total of 5,069 cases. Median pain reduction for at least 3 months was reported in 60% (5-100%), median pain reduction for at least 12 months in 40% (10-100%), and median persistent pain reduction in 27.8% (10-85%) of the treated patients. In 30% of patients (7-100%), a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed. CONCLUSION This PCS comprises the largest number of cases reported for RT in painful and refractory GNA. Despite variations in daily RT practice, high response and low toxicity for this treatment in a very large number of painful and refractory GNA cases renders low-dose RT an effective conservative therapy which can be applied prior to surgical procedures.Hintergrund und Ziel:Nach einer Patterns-of-Care-Studie (PCS) der AG Strahlentherapie gutartiger Erkrankungen der Deutschen Gesellschaft für Radioonkologie (DEGRO) 2003/2004 ist eine Vielzahl von einzelnen PCS zu unterschiedlichen gutartigen Erkrankungen durchgeführt worden. Hier wird nun die PCS betreffend Radiotherapie (RT) bei schmerzhafter Gonarthrose (GNA) vorgestellt.Material und Methodik:Von 2006 bis 2008 wurden alle deutschen strahlentherapeutischen Institutionen mit Hilfe eines standardisierten Fragebogens hinsichtlich Patientenzuweisung und -anzahl, Anamnese, Vorbehandlungen, Bestrahlungsindikationen und -techniken, Zielvolumenkonzepten usw. sowie Behandlungsergebnissen betreffend RT bei schmerzhafter GNA befragt.Ergebnisse:Insgesamt beantworteten 238/248 (95,9%) der strahlentherapeutischen Einrichtungen in Deutschland den Fragebogen. 188/238 (79%) der strahlentherapeutischen Einrichtungen führen eine RT bei schmerzhafter GNA durch. Jährlich wurden in Deutschland 4 544 Patienten (im Median 15 pro Institution; ein bis 846) mit schmerzhafter GNA bestrahlt. Indikationen waren akute Schmerzen in 18,9%, chronische Schmerzen in 95,3% sowie therapierefraktäre Schmerzen in 81,1%. Die im Median applizierte Gesamtdosis betrug 6 Gy (3–12 Gy) bei einer medianen Einzeldosis von 1 Gy (0,25–3 Gy). 40,4% der Institutionen bestrahlten zweimal pro Woche, 51,4% dreimal pro Woche. Die RT wurde in 25% der Fälle mit einem Orthovoltgerät, in 79,6% mit einem Linearbeschleuniger und in 8,3% mit einem Cobalt-60-Gerät durchgeführt. 42 Einrichtungen evaluierten die Resultate der RT von insgesamt 5 069 behandelten Patienten. Eine mediane Schmerzreduktion von mindestens 3 Monaten konnte in 60% (5–100%), eine mediane Schmerzreduktion von mindestens 12 Monaten in 40% (10–100%) und eine mediane dauerhafte Schmerzreduktion in 27,8% (10–85%) der bestrahlten Patienten erreicht werden. Im Median erhielten 30% (7–100%) der Patienten eine zweite Bestrahlungsserie. Es wurden keine radiogenen Akut- und Spätreaktionen angegeben.Schlussfolgerung:Die vorliegende PCS bestätigt mit der bisher weltweit größten Fallzahl die traditionell weite Verbreitung der RT bei der schmerzhaften GNA in Deutschland sowie die damit verbundenen sehr guten Resultate. Die RT bei schmerzhafter GNA kann als effektive und nebenwirkungsfreie Option vor operativen Eingriffen durchgeführt werden.Backgroud and Purpose:After a patterns-of-care study (PCS) in 2003/2004 addressing benign disorders in general, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) conducted several multicenter cohort studies including the use of radiotherapy (RT) in painful gonarthrosis (GNA).Material and Methods:From 2006 to 2008, a PCS for GNA was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful GNA were assessed. In addition, the long-term functional and subjective outcomes were evaluated.Results:238/248 institutions (95.9%) returned the questionnaire: 50 (21%) reported no clinical experience with RT in GNA, while 188 (79%) institutions treated 4,544 patients annually (median 15; range one to 846 cases per institution). Indications for treatment were acute pain symptoms in 18.9%, chronic pain in 95.3%, and treatment-refractory pain in 81.1%. The median total dose was 6 Gy (range 3–12 Gy), with a median single dose of 1 Gy (0.25–3 Gy). 40.4% of the institutions applied two fractions and 51.4% three fractions weekly. RT was delivered with orthovoltage units (25%), linear accelerators (79.6%), and cobalt-60 units (8.3%). 42 institutions evaluated the long-term clinical outcome in a total of 5,069 cases. Median pain reduction for at least 3 months was reported in 60% (5–100%), median pain reduction for at least 12 months in 40% (10–100%), and median persistent pain reduction in 27.8% (10–85%) of the treated patients. In 30% of patients (7–100%), a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed.Conclusion:This PCS comprises the largest number of cases reported for RT in painful and refractory GNA. Despite variations in daily RT practice, high response and low toxicity for this treatment in a very large number of painful and refractory GNA cases renders low-dose RT an effective conservative therapy which can be applied prior to surgical procedures.

Correspondence (letter to the editor): low-dose radiotherapy.

As practicing radiooncologists, we missed a mention of low-dose radiotherapy in the context of conservative treatment in the article, since it has traditionally been much used in Germany and is recognized among orthopedic specialists. The so called x-ray stimulation radiotherapy is used everyday in many patients, including patients with osteoarthritis of the knee, and we would have appreciated at least a brief mention of this method. Even though randomized controlled studies for this special indication are thus far lacking, many publications of retrospective analyses, including patterns of care studies (PCS), are available.In 2004, investigators noted in the context of such a PCS that every year, 23 752 patients in Germany with degenerative joint disorders, including osteoarthritis of the knee, received x-ray stimulation radiotherapy (1).. In 2004, an orthopedic specialist published the results of a retrospective study with a success rate (pain reduction, absence of pain) of 63% after radiotherapy for osteoarthritis of the knee. A PCS published in 2010 showed that in Germany in 2007, 4544 patients with osteoarthritis of the knee received radiotherapy. Referrals for radiotherapy were made by orthopedic specialists (95.2%), general practitioners (84.6%), surgeons (28.8%), and other specialists (27.9%) (multiple mentions permitted). 25% of patients were free from pain, and a moderate to notable reduction in pain was achieved in 55% of patients who had received radiotherapy (3). From a radiotherapeutic perspective, low-dose radiotherapy for painful Kellgren stage 2–3 osteoarthritis of the knee at is an effective therapeutic option and can be recommended or undertaken even if surgical interventions are not possible or desirable.

Radiotherapy of splenomegaly

Purpose:Since the 20th century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT.Material and Methods: Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects.Results:From 1989–2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with 60Co gamma rays or 5–15MV photons. The fraction size ranged from 10–200 cGy and the total dose per treatment course from 30–1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II°.Conclusion:The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten.Einleitung:Seit Beginn des 20. Jahrhunderts hat die Radiotherapie (RT) ihren festen Stellenwert in der Behandlung einer symptomatischen Splenomegalie (SM). Die SM tritt bei hämatologischen Erkrankungen auf. Klinisch stehen Kapselschmerz sowie eine Zytopenie im Vordergrund. Die vorliegende Analyse untersucht Indikation, RT-Konzepte und die Effektivität der RT.Material und Methode:Patientendaten der letzten 20 Jahre wurden hinsichtlich klinischer Angaben, RT-Konzepte und Ergebnisse evaluiert. Endpunkte waren Schmerzfreiheit, hämatologisches Ansprechen nach RT sowie therapieassoziierte Nebenwirkungen.Ergebnisse:Zwischen 1989 und 2009 wurden 122 Patienten (79 Männer und 43 Frauen) mit insgesamt 246 RT-Serien behandelt. Folgende Grunderkrankungen waren Ursache für die Splenomegalie: CML (31), CLL (37), Osteomyelofibrose, (23), Polycyt haemia vera (17), AML (5), idiopathische Thrombozytopenie (4), Non-Hodgkin-Lymphom (3) und Plasmozytom (2) (Tabelle1). Die Behandlung erfolgte am Telekobalttherapiegerät oder am Linearbeschleuniger (5–15 MeV Photonen). Es wurden Einzelreferenzdosen zwischen 0,1–2 Gy und Gesamtreferenzdosen zwischen 3–16 Gy appliziert (Tabelle 2). Bei 74,8% der RT-Serien (74,8%), die aufgrund einer schmerzhaften Splenomegalie durchgeführt wurden, konnte eine Schmerzlinderung erzielt werden. Bei 77% der RT-Serien kam es zu einer Verkleinerung der Milz um bis zu 50% (Abbildung 1). 36 Patienten verstarben weniger als 2 Monaten nach Abschluss der RT im Rahmen der infausten Prognose ihrer Grunderkrankung. Bei 73,6% der RT-Serien kam es zu einer Verbesserung hinsichtlich Thrombozytopenien und die Transfusionsfrequenz nahm ab (Tabelle 3). Es wurden lediglich hämatologische Toxizitäten < II° (EORTC/RTOG) beobachtet.Schlussfolgerung:Die vorliegende Analyse belegt die hohe Effektivität der RT bei geringem Nebenwirkungsspektrum. Die RT der symptomatischen Splenomegalie sollte als wirksame palliative Option nicht in Vergessenheit geraten.

Complementary and alternative medicine experience in radiation oncology patients : first results of a multi-center approach

In recent years the demand and use of complementary and alternative medicine (CAM) in malignant diseases has increased noticeably. Since the general knowledge about CAM use is scant and CAM could potentially interact with standard therapies the German Working group “Trace Elements and Electrolytes in Oncology” performed a multi-centric study to comprehensively evaluate the use of CAM therapies in cancer patients treated with radiotherapy. Methods: 1,013 patients receiving consecutively radiotherapy for malignant diseases were interviewed using a standardized questionnaire including clinical and pathological tumor parameters as well as the type of CAM and reasons for CAM use. A self-assessment of patients’ personal conditions was performed in order to evaluate the subjective impact of CAM on quality of life. Results: A total of 59% of patients reported using CAM therapies. CAM use was more common in female patients, generally higher in advanced stages of disease and most common in breast cancer patients. Most frequently reported CAM therapies were vitamins (18%), mistletoe extracts (15%), selenium (10%), and other trace element preparations (7%). Multivariate logistic regression showed age, gender, tumor type and stage, and smoking behavior to be significant predictors for CAM use. A subjective improvement in quality of life due to the use of CAM was accounted for in 30% of patients. Conclusions: More than half of patients undergoing RT for cancer are using CAM therapies. Therefore, radiation oncologists should be asking for respective obtaining information about CAM use in order to avoid harmful interactions with conventional therapies. The value and potential hazards of such combined treatments have yet to be tested in further clinical studies.

Calcaneodynia: Plantar and Dorsal Heel Spur/Heel Spur Syndrome

Painful heel spur (plantar fasciitis) is a major part of the heel spur syndrome. It is reportedly the most common cause of pain in the inferior heel and is estimated to account for 11% to 15% of all foot symptoms requiring professional care among adults [17]. The first description of the clinical picture in the literature came from Wood in 1812, but he incorrectly attributed it to tuberculosis [11, 68]. During the Civil War, another early citing by Zacharie in 1860 discussed a condition affecting the heel in which patients had “greater pain in the morning than after standing and walking one or two hours” [153].

Low-dose analgesic radiotherapy is a real alternative.

As board members of the working group “Gutartige Erkrankungen [benign disorders]” within the German Society of Radiation Oncology (DEGRO, Deutsche Gesellschaft fur Radioonkologie), we read the original article by Holland et al. with great interest. The article shows that the risks associated with cortisone injections—a popular measure in the setting of painful skeletal disorders—are not as low as is commonly assumed (1). We are practicing radiation oncologists and would therefore unreservedly support the authors’ crucial conclusion—namely, that, concerning patient safety, the indication for invasive therapeutic options should always be critically defined and patients should be informed about associated risks. In view of the ageing population and the corresponding increase in painful degenerative disorders of joints and entheses, low dose radiotherapy offers a low-risk, genuinely conservative, non-invasive therapeutic alternative. This treatment is administered to many patients every day. A patterns of care study published in 2004 showed that 23 752 patients with degenerative disorders receive low-dose analgesic radiotherapy in Germany every year (2) and that the trend is upwards. Another patterns of care study showed that in Germany in 2007, 4544 patients with painful osteoarthritis of the knee received low-dose radiotherapy. In 25% of patients this treatment resulted in a complete resolution of pain, and a moderate to notable reduction in pain was achieved in 55% of patients (3). A current randomized study in patients with painful heel spur also showed a significant advantage for a total dose of 6 Gy compared to a very low total dose of 0.6 Gy, thus showing a clinical effect of the fractionation and dosage that is widely used in Germany (4). Finally it should be mentioned that low-dose analgesic radiotherapy is not named in the medical expert committees and mediation boards generally, and that it is a accredited service covered by the health insurers in Germany.

Selenium in Radiation Oncology

Selenium measurement and supplementation in radiation oncology is a controversial issue. Selenium has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. Recent clinical trials showed the importance of selenium for clinical radiation oncology. This overview outlines the most important results from literature and our own experience. Additionally, we want to point out the future scientific topics. Moreover, we highlight strategies for identifying those tumor patients who might benefit most from selenium, and we discuss the potential benefits and risks of this selenium supplementation. In conclusion, selenium supplementation yielded promising results concerning radioprotection in tumor patients and should be considered as a meaningful adjuvant treatment option in subjects with a low selenium status.

The prognostic value of irradiated lung volumes on the prediction of intra-/ post-operative mortality in patients after neoadjuvant radiochemotherapy for esophageal cancer. A retrospective multicenter study.

Purpose: To assess the association between dosimetric factors of the lung and incidence of intra- and postoperative mortality among esophageal cancer (EC) patients treated with neoadjuvant radiochemotherapy (N-RCT) followed by surgery (S). Methods and Materials: Inclusion criteria were: age < 85 years, no distant metastases at the time of diagnosis, no induction chemotherapy, conformal radiotherapy, total dose ≤ 50.4 Gy, and available dose volume histogram (DVH) data. One-hundred thirty-five patients met our inclusion criteria. Median age was 62 years. N-RCT consisted of 36 - 50.4 Gy (median 45 Gy), 1.8 - 2 Gy per fraction. Concomitant chemotherapy consisted of 5-Fluoruracil (5-FU) and cisplatin in 113 patients and cisplatin and taxan-derivates in 15 patients. Seven patients received a single cytotoxic agent. In 130 patients an abdominothoracal and in 5 patients a transhiatal resection was performed. The following dosimetric parameters were generated from the total lung DVH: mean dose, V5, V10, V15, V20, V30, V40, V45 and V50. The primary endpoint was the rate of intra- and postoperative mortality (from the start of N-RCT to 60 days after surgical resection). Results: A total of ten postoperative deaths (7%) were observed: 3 within 30 days (2%) and 7 between 30 and 60 days after surgical intervention (5%); no patient died during the operation. In the univariate analysis, weight loss (≥10% in 6 months prior to diagnosis, risk ratio: 1.60, 95%CI: 0.856-2.992, p=0.043), Eastern Cooperative Oncology Group-performance status (ECOG 2 vs. 1, risk ratio: 1.931, 95%CI: 0.898-4.150, p=0.018) and postoperative pulmonary plus non-pulmonary complications (risk ratio: 2.533, 95%CI: 0.978-6.563, p=0.004) were significantly associated with postoperative mortality. There was no significant association between postoperative mortality and irradiated lung volumes. Lung V45 was the only variable which was significantly associated with higher incidence of postoperative pulmonary plus non-pulmonary complications (Exp(B): 1.285, 95%CI 1.029-1.606, p=0.027), but not with the postoperative pulmonary complications (Exp(B): 1.249, 95%CI 0.999-1.561, p=0.051). Conclusions: Irradiated lung volumes did not show relevant associations with intra- and postoperative mortality of patients treated with moderate dose (36 - 50.4 Gy) conventionally fractionated conformal radiotherapy combined with widely used radiosensitizers. Postoperative mortality was significantly associated with greater weight loss, poor performance status and development of postoperative complications, but not with treatment-related factors. Limiting the volume of lung receiving higher radiation doses appears prudent because of the observed association with risk of postoperative complications.

Radiotherapy of splenomegaly@@@Radiotherapie der Splenomegalie. Eine palliative Behandlungsmodalität eines benignen Symptoms bei hämatoonkologischen Erkrankungen: A palliative treatment option for a benign phenomenon in malignant diseases

Purpose:Since the 20th century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT.Material and Methods: Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects.Results:From 1989–2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with 60Co gamma rays or 5–15MV photons. The fraction size ranged from 10–200 cGy and the total dose per treatment course from 30–1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II°.Conclusion:The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten.Einleitung:Seit Beginn des 20. Jahrhunderts hat die Radiotherapie (RT) ihren festen Stellenwert in der Behandlung einer symptomatischen Splenomegalie (SM). Die SM tritt bei hämatologischen Erkrankungen auf. Klinisch stehen Kapselschmerz sowie eine Zytopenie im Vordergrund. Die vorliegende Analyse untersucht Indikation, RT-Konzepte und die Effektivität der RT.Material und Methode:Patientendaten der letzten 20 Jahre wurden hinsichtlich klinischer Angaben, RT-Konzepte und Ergebnisse evaluiert. Endpunkte waren Schmerzfreiheit, hämatologisches Ansprechen nach RT sowie therapieassoziierte Nebenwirkungen.Ergebnisse:Zwischen 1989 und 2009 wurden 122 Patienten (79 Männer und 43 Frauen) mit insgesamt 246 RT-Serien behandelt. Folgende Grunderkrankungen waren Ursache für die Splenomegalie: CML (31), CLL (37), Osteomyelofibrose, (23), Polycyt haemia vera (17), AML (5), idiopathische Thrombozytopenie (4), Non-Hodgkin-Lymphom (3) und Plasmozytom (2) (Tabelle1). Die Behandlung erfolgte am Telekobalttherapiegerät oder am Linearbeschleuniger (5–15 MeV Photonen). Es wurden Einzelreferenzdosen zwischen 0,1–2 Gy und Gesamtreferenzdosen zwischen 3–16 Gy appliziert (Tabelle 2). Bei 74,8% der RT-Serien (74,8%), die aufgrund einer schmerzhaften Splenomegalie durchgeführt wurden, konnte eine Schmerzlinderung erzielt werden. Bei 77% der RT-Serien kam es zu einer Verkleinerung der Milz um bis zu 50% (Abbildung 1). 36 Patienten verstarben weniger als 2 Monaten nach Abschluss der RT im Rahmen der infausten Prognose ihrer Grunderkrankung. Bei 73,6% der RT-Serien kam es zu einer Verbesserung hinsichtlich Thrombozytopenien und die Transfusionsfrequenz nahm ab (Tabelle 3). Es wurden lediglich hämatologische Toxizitäten < II° (EORTC/RTOG) beobachtet.Schlussfolgerung:Die vorliegende Analyse belegt die hohe Effektivität der RT bei geringem Nebenwirkungsspektrum. Die RT der symptomatischen Splenomegalie sollte als wirksame palliative Option nicht in Vergessenheit geraten.

Strahlentherapie bei schmerzhafter Kniegelenkarthrose (Gonarthrose)@@@Radiotherapy in Painful Gonarthrosis. Results of a National Patterns-of-Care Study: Ergebnisse einer deutschen Patterns-of-Care-Studie*

BACKGROUND AND PURPOSE After a patterns-of-care study (PCS) in 2003/2004 addressing benign disorders in general, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) conducted several multicenter cohort studies including the use of radiotherapy (RT) in painful gonarthrosis (GNA). MATERIAL AND METHODS From 2006 to 2008, a PCS for GNA was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful GNA were assessed. In addition, the long-term functional and subjective outcomes were evaluated. RESULTS 238/248 institutions (95.9%) returned the questionnaire: 50 (21%) reported no clinical experience with RT in GNA, while 188 (79%) institutions treated 4,544 patients annually (median 15; range one to 846 cases per institution). Indications for treatment were acute pain symptoms in 18.9%, chronic pain in 95.3%, and treatment-refractory pain in 81.1%. The median total dose was 6 Gy (range 3-12 Gy), with a median single dose of 1 Gy (0.25-3 Gy). 40.4% of the institutions applied two fractions and 51.4% three fractions weekly. RT was delivered with orthovoltage units (25%), linear accelerators (79.6%), and cobalt-60 units (8.3%). 42 institutions evaluated the long-term clinical outcome in a total of 5,069 cases. Median pain reduction for at least 3 months was reported in 60% (5-100%), median pain reduction for at least 12 months in 40% (10-100%), and median persistent pain reduction in 27.8% (10-85%) of the treated patients. In 30% of patients (7-100%), a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed. CONCLUSION This PCS comprises the largest number of cases reported for RT in painful and refractory GNA. Despite variations in daily RT practice, high response and low toxicity for this treatment in a very large number of painful and refractory GNA cases renders low-dose RT an effective conservative therapy which can be applied prior to surgical procedures.Hintergrund und Ziel:Nach einer Patterns-of-Care-Studie (PCS) der AG Strahlentherapie gutartiger Erkrankungen der Deutschen Gesellschaft für Radioonkologie (DEGRO) 2003/2004 ist eine Vielzahl von einzelnen PCS zu unterschiedlichen gutartigen Erkrankungen durchgeführt worden. Hier wird nun die PCS betreffend Radiotherapie (RT) bei schmerzhafter Gonarthrose (GNA) vorgestellt.Material und Methodik:Von 2006 bis 2008 wurden alle deutschen strahlentherapeutischen Institutionen mit Hilfe eines standardisierten Fragebogens hinsichtlich Patientenzuweisung und -anzahl, Anamnese, Vorbehandlungen, Bestrahlungsindikationen und -techniken, Zielvolumenkonzepten usw. sowie Behandlungsergebnissen betreffend RT bei schmerzhafter GNA befragt.Ergebnisse:Insgesamt beantworteten 238/248 (95,9%) der strahlentherapeutischen Einrichtungen in Deutschland den Fragebogen. 188/238 (79%) der strahlentherapeutischen Einrichtungen führen eine RT bei schmerzhafter GNA durch. Jährlich wurden in Deutschland 4 544 Patienten (im Median 15 pro Institution; ein bis 846) mit schmerzhafter GNA bestrahlt. Indikationen waren akute Schmerzen in 18,9%, chronische Schmerzen in 95,3% sowie therapierefraktäre Schmerzen in 81,1%. Die im Median applizierte Gesamtdosis betrug 6 Gy (3–12 Gy) bei einer medianen Einzeldosis von 1 Gy (0,25–3 Gy). 40,4% der Institutionen bestrahlten zweimal pro Woche, 51,4% dreimal pro Woche. Die RT wurde in 25% der Fälle mit einem Orthovoltgerät, in 79,6% mit einem Linearbeschleuniger und in 8,3% mit einem Cobalt-60-Gerät durchgeführt. 42 Einrichtungen evaluierten die Resultate der RT von insgesamt 5 069 behandelten Patienten. Eine mediane Schmerzreduktion von mindestens 3 Monaten konnte in 60% (5–100%), eine mediane Schmerzreduktion von mindestens 12 Monaten in 40% (10–100%) und eine mediane dauerhafte Schmerzreduktion in 27,8% (10–85%) der bestrahlten Patienten erreicht werden. Im Median erhielten 30% (7–100%) der Patienten eine zweite Bestrahlungsserie. Es wurden keine radiogenen Akut- und Spätreaktionen angegeben.Schlussfolgerung:Die vorliegende PCS bestätigt mit der bisher weltweit größten Fallzahl die traditionell weite Verbreitung der RT bei der schmerzhaften GNA in Deutschland sowie die damit verbundenen sehr guten Resultate. Die RT bei schmerzhafter GNA kann als effektive und nebenwirkungsfreie Option vor operativen Eingriffen durchgeführt werden.Backgroud and Purpose:After a patterns-of-care study (PCS) in 2003/2004 addressing benign disorders in general, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) conducted several multicenter cohort studies including the use of radiotherapy (RT) in painful gonarthrosis (GNA).Material and Methods:From 2006 to 2008, a PCS for GNA was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful GNA were assessed. In addition, the long-term functional and subjective outcomes were evaluated.Results:238/248 institutions (95.9%) returned the questionnaire: 50 (21%) reported no clinical experience with RT in GNA, while 188 (79%) institutions treated 4,544 patients annually (median 15; range one to 846 cases per institution). Indications for treatment were acute pain symptoms in 18.9%, chronic pain in 95.3%, and treatment-refractory pain in 81.1%. The median total dose was 6 Gy (range 3–12 Gy), with a median single dose of 1 Gy (0.25–3 Gy). 40.4% of the institutions applied two fractions and 51.4% three fractions weekly. RT was delivered with orthovoltage units (25%), linear accelerators (79.6%), and cobalt-60 units (8.3%). 42 institutions evaluated the long-term clinical outcome in a total of 5,069 cases. Median pain reduction for at least 3 months was reported in 60% (5–100%), median pain reduction for at least 12 months in 40% (10–100%), and median persistent pain reduction in 27.8% (10–85%) of the treated patients. In 30% of patients (7–100%), a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed.Conclusion:This PCS comprises the largest number of cases reported for RT in painful and refractory GNA. Despite variations in daily RT practice, high response and low toxicity for this treatment in a very large number of painful and refractory GNA cases renders low-dose RT an effective conservative therapy which can be applied prior to surgical procedures.