The value of radiotherapy in the treatment of pain in the degenerative bones diseases

The degenerative joint diseases are widely seen in the population and mainly affects people between 40-70 years of age. The literature data suggests that for those sufferers whose pharmacological treatment has failed, symptomatic relief can be obtained with the use of radiotherapy. Although the way the treatment works is not fully known, radiotherapy has for long been used to treat painful joints. The efficacy of radiotherapy for degenerative-inflammatory disorders is well known, but so far long-term observations and reliable assessment of symptoms according to objective criteria and scores for validation are still missing. Due to the very low risk of side effects and low costs, radiotherapy provides an excellent alternative to conventional conservative treatment methods.
In recent years, treatment of benign disease has again attracted the interest of the radiation oncology community in the Western part of the world. For several decades, irradiation of benign disorders was common practice. However, in the 1960s the risk of induction of secondary cancers, especially leukemia, became known. For that reason, in many countries, especially in the Western part of the world, irradiation of benign diseases gradually became less acceptable as good medical practice and most indications disappeared. However, this was not the case in some more Eastern parts of Europe. Radiotherapy has been given successfully to patients suffering from a wide variety diseases.
In several randomized recent studies, however, only patients who were refractory to standard treatments were given radiotherapy for painful degenerative joint disorders. There is wide variation with respect to treatment schedules as shown by the total dose stated for a selection of benign diseases. No randomized, double blind study has been performed on the effectiveness of radiotherapy for those patients suffering from painful, degenerative joint diseases who were refractory to first line conservative treatment, e.g. NSAIDs or/and physiotherapy.
Using modern techniques, smaller fields and lower doses, the risk of secondary tumors, especially in the older age group, might be less than previously estimated and the risks of radiotherapy must be balanced against the risks of alternative treatments which are also not negligible.
The role of radiotherapy in the treatment of degenerative diseases is still controversial. Randomized clinical studies are required to find the optimal dosage which, at present, may be unnecessarily high.