As board members of the working group “Gutartige Erkrankungen [benign disorders]” within the German Society of Radiation Oncology (DEGRO, Deutsche Gesellschaft für 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.

DOI: 10.3238/arztebl.2013.0010a

Dr. med. Ralph Mücke

Klinikum Lippe GmbH, Lemgo

ralph.muecke@klinikum-lippe.de

Prof. Dr. med. Oliver Micke, Franziskus Hospital Bielefeld
Prof. Dr. med. Ulrich Schäfer, Klinikum Lippe GmbH, Lemgo
Prof. Dr. med. Michael Heinrich Seegenschmiedt, Strahlenzentrum
Hamburg, Klinikum Lippe GmbH, Lemgo

Conflict of interest statement
The authors declare that no conflict of interest exists.

1.
Holland C, Jaeger L, Smentkowski U, Weber B, Otto C: Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009. Dtsch Arztebl Int 2012; 109(24): 425–30. VOLLTEXT
2.
Seegenschmiedt MH, Micke O, Willich N, et al.: Radiation therapy for nonmalignant diseases in Germany. Strahlenther Onkol 2004; 180: 718–30. CrossRef MEDLINE
3.
Mücke R, Seegenschmiedt MH, Heyd R, et al.: Strahlentherapie bei schmerzhafter Kniegelenksarthrose – Ergebnisse einer deutschen Patterns of Care Studie. Strahlenther Onkol 2010; 186: 7–17. CrossRef MEDLINE
4.
Niewald M, Seegenschmiedt MH, Micke O, et al.: Randomized multicenter trial on the effect of radiotherapy on plantar fasciitis (painful heel spur) comparing a standard dose to a very low one – mature results after 12 months´ follow-up. Int J Radiat Oncol Biol Phys 2012; [in press]. CrossRef MEDLINE
1. Holland C, Jaeger L, Smentkowski U, Weber B, Otto C: Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009. Dtsch Arztebl Int 2012; 109(24): 425–30. VOLLTEXT
2. Seegenschmiedt MH, Micke O, Willich N, et al.: Radiation therapy for nonmalignant diseases in Germany. Strahlenther Onkol 2004; 180: 718–30. CrossRef MEDLINE
3. Mücke R, Seegenschmiedt MH, Heyd R, et al.: Strahlentherapie bei schmerzhafter Kniegelenksarthrose – Ergebnisse einer deutschen Patterns of Care Studie. Strahlenther Onkol 2010; 186: 7–17. CrossRef MEDLINE
4. Niewald M, Seegenschmiedt MH, Micke O, et al.: Randomized multicenter trial on the effect of radiotherapy on plantar fasciitis (painful heel spur) comparing a standard dose to a very low one – mature results after 12 months´ follow-up. Int J Radiat Oncol Biol Phys 2012; [in press]. CrossRef MEDLINE

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