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.