Radiation therapy for OA?

[dozitgetchahi]

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I’m a rheumatologist…at my multispecialty PP, my CMO came to me recently and told me they were interviewing a rad onc candidate who was keen on doing RT for OA of various joints. He wanted to know what I thought of this.

I’ve reviewed some articles and the data seems somewhat spotty etc. Is this a legit treatment modality for OA? Is this something that is done out there with any frequency? I’d never really heard of it until he brought it up.

 

[catachip]

It’s legit and used extensively in Europe, especially Germany. Americans are just afraid of radiation.

 

[elementaryschooleconomics]

I personally use this quite frequently in my own practice. Many other posters you'll find here do as well.

It works. If you stumble upon those stupid "randomized control trials" from 2017/2018 - they're hot garbage and not worth the paper they're printed on. They treated less than 30 people in the experimental arm and powered the stats to only be positive with a 40% improvement...in severe, chronic pain patients. Not even fentanyl can do that.

There's never been a recorded case of secondary malignancy with LDRT either. It's 1/20th the dose we use to treat cancer (or lower). We're not trying to kill cells so much as alter inflammatory cytokines and cell signaling.

Insurance almost always pays for it (unless you get a dummy with an axe to grind at a local level). I've never had a denial, personally.

I still can't believe it sort of...died in America. I've literally seen people stop walking with a cane after I've treated their knees. It's insane.

 

[thesauce]

Yes. It is covered by most insurances including Medicare and works great

 

[SneakyBooger]

I've treated over a thousand joints.

 

[Neuronix]

I’m a rheumatologist…at my multispecialty PP, my CMO came to me recently and told me they were interviewing a rad onc candidate who was keen on doing RT for OA of various joints. He wanted to know what I thought of this.

I’ve reviewed some articles and the data seems somewhat spotty etc. Is this a legit treatment modality for OA? Is this something that is done out there with any frequency? I’d never really heard of it until he brought it up.

You should hire that rad onc candidate IMO. That's a forward thinking, practice growing person.

 

[evilbooyaa]

I’m a rheumatologist…at my multispecialty PP, my CMO came to me recently and told me they were interviewing a rad onc candidate who was keen on doing RT for OA of various joints. He wanted to know what I thought of this.

I’ve reviewed some articles and the data seems somewhat spotty etc. Is this a legit treatment modality for OA? Is this something that is done out there with any frequency? I’d never really heard of it until he brought it up.

The TL;DR:
Very commonly used in Germany.

Some people in Europe (not Germany) ran extremely underpowered phIII trials and got a negative result. They also did the radiation in a different manner than the Germans do.

There are now a multitude of people doing this off-protocol since the RT dose is so incredibly low and seeing significant clinical benefit.

There are some ph II trials actively enrolling around the country for this as well, replicating the German experience. Eventual plan to run a phIII version of them.

 

[fiji128]

 

[A_DeMichele]

1 Gy X 3?
What's the most common planning technique

 

[RadOncMegatron]

Really interesting stuff here. How has the buy in been from primary care and ortho?

 

[CaesarRO]

1 Gy X 3?
What's the most common planning technique

0.5 Gy x 6 QOD

The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review - PubMed

Despite its clinical use and investigation in other countries, low dose radiation therapy (LDRT) in the treatment of osteoarthritis (OA) is minimally used in the United States (US). Numerous recent studies published outside the US have shown moderate to long-term pain relief and improvement of...

pubmed.ncbi.nlm.nih.gov

 

[NotMattSpraker]

Really interesting stuff here. How has the buy in been from primary care and ortho?

Primary care and similar specialities seem to like it; they like more options and it works.

Ortho has been variable for me. Some are very interested to the point where they are taking the lead of building a program (N=1 experience for me) and some seem to not believe in it.

Occupational medicine, family medicine, and geriatrics are other good places for outreach if you are interested in building a program.

I literally just had a referral of a patient who asked the PCP for this treatment. They read about LDRT in an article from a competing cancer center then somehow discovered that I do this treatment and asked for a referral (they live closer to me).

I think you will see an explosion of programs and advertisements over the next 1-2 years.

 

[DrProtonX]

Primary care and similar specialities seem to like it; they like more options and it works.

Ortho has been variable for me. Some are very interested to the point where they are taking the lead of building a program (N=1 experience for me) and some seem to not believe in it.

Occupational medicine, family medicine, and geriatrics are other good places for outreach if you are interested in building a program.

I literally just had a referral of a patient who asked the PCP for this treatment. They read about LDRT in an article from a competing cancer center then somehow discovered that I do this treatment and asked for a referral (they live closer to me).

I think you will see an explosion of programs and advertisements over the next 1-2 years.

Orthorad to save the field?

 

[Fpg1245]

Orthorad to save the field?

Ortho group would probably buy a linac and do it themselves. I remember 15 years ago they were gonna hire a rad onc to do HO treatments on their joint replacement patients

I dont think they fully understood the economics of that’s decision.

 

[A_DeMichele]

0.5 Gy x 6 QOD

The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review - PubMed

Despite its clinical use and investigation in other countries, low dose radiation therapy (LDRT) in the treatment of osteoarthritis (OA) is minimally used in the United States (US). Numerous recent studies published outside the US have shown moderate to long-term pain relief and improvement of...

pubmed.ncbi.nlm.nih.gov

Thanks. For hands, one would use 3D AP / PA, correct?

 

[OTN]

Ortho group would probably buy a linac and do it themselves. I remember 15 years ago they were gonna hire a rad onc to do HO treatments on their joint replacement patients

I dont think they fully understood the economics of that’s decision.

I haven't seen a machine cheap enough to justify a pro forma for OA tx alone

 

[Mandelin Rain]

I haven't seen a machine cheap enough to justify a pro forma for OA tx alone

Why buy a linac when you can buy a "Lazer"?

 

[evilbooyaa]

1 Gy X 3?
What's the most common planning technique

0.5Gy x 6 - either QOD, some people do 2x/week.

Complex isodose. Does not realistically meet any sort of justification for 3D. Usually AP/PA. I prefer doing CT sim but some don't.

 

[JustAdocInBox]

When patients need a second round of treatment for inadequate pain response, are you guys billing it as a new course or continuing the prior plan?

 

[OTN]

When patients need a second round of treatment for inadequate pain response, are you guys billing it as a new course or continuing the prior plan?

new course

 

[metallica81788]

0.5Gy x 6 - either QOD, some people do 2x/week.

Complex isodose. Does not realistically meet any sort of justification for 3D. Usually AP/PA. I prefer doing CT sim but some don't.

Do you or anybody else have any anecdotes re treating 2x/week?
I've done QOD MWF but logistically I like the idea of treating TTh instead of MWF

 

[thesauce]

Do you or anybody else have any anecdotes re treating 2x/week?
I've done QOD MWF but logistically I like the idea of treating TTh instead of MWF

I've only done twice weekly and seems to work fine

 

[PharMed2016]

Twice or Thrice weekly is fine - 3Gy in 6 fractions.

 

[Gfunk6]

Protons for OA!

Why deal with the severe dermatitis + joint/tendon/muscle fibrosis that is a side effect of photos delivered at ablative doses of 0.5 Gy QOD to 3 Gy???

Patients now have options and no longer need to deal with wholly unnecessary toxicity of photons for OA.

 

[BobbyHeenan]

Protons for OA!

Why deal with the severe dermatitis + joint/tendon/muscle fibrosis that is a side effect of photos delivered at ablative doses of 0.5 Gy QOD to 3 Gy???

Patients now have options and no longer need to deal with wholly unnecessary toxicity of photons for OA.

View attachment 393580

I thought this was an AI generated parody.

My goodness.

 

[metallica81788]

Protons for OA!

Why deal with the severe dermatitis + joint/tendon/muscle fibrosis that is a side effect of photos delivered at ablative doses of 0.5 Gy QOD to 3 Gy???

Patients now have options and no longer need to deal with wholly unnecessary toxicity of photons for OA.

View attachment 393580

The grift never stops
Screw this guy

 

[OTN]

At some point the brazenness of the grift becomes so large it becomes impressive. Bravo, Dr. Marash. Bravo.

 

[thesauce]

Desperation move coming from the proton companies.

Likely anyone in the process of buying a proton center when the randomized trial came out showing all it offers is more erectile dysfunction is pulling out of the deal. Need to salvage your business anyway you can think of.

 

[drowsy12]

Desperation move coming from the proton companies.

Likely anyone in the process of buying a proton center when the randomized trial came out showing all it offers is more erectile dysfunction is pulling out of the deal. Need to salvage your business anyway you can think of.

I assure you these people are not worried in the slightest.

 

[fiji128]

I assure you these people are not worried in the slightest.

why?

 

[drowsy12]

why?

Do you think people are going to stop offering proton for prostate CA?

 

[OTN]

Do you think people are going to stop offering proton for prostate CA?

See my other post - large academic medical centers have not stopped offering it after ASTRO.

 

[fiji128]

Paper needs to be published first and if that makes it into the nccn guidelines I don't see how that doesn't begin to be a significant headwind with prostate dependent proton shops.

 

[Gfunk6]

Rather than protons for OA, it would probably be cheaper to simply start over.

 

[thesauce]

Do you think people are going to stop offering proton for prostate CA?

I would think/hope many of the academic centers would at a minimum. They enrolled patients on the trial to answer that exact question.

 

[OTN]

I would think/hope many of the academic centers would at a minimum. They enrolled patients on the trial to answer that exact question.

They will not, at least the large academic medical center that saw my patient last week did not.

 

[medgator]

I would think/hope many of the academic centers would at a minimum. They enrolled patients on the trial to answer that exact question.

They won't

x.com

x.com

 

[radoncftw]

They will not, at least the large academic medical center that saw my patient last week did not.

upton sinclair

 

[evilbooyaa]

Protons for OA!

Why deal with the severe dermatitis + joint/tendon/muscle fibrosis that is a side effect of photos delivered at ablative doses of 0.5 Gy QOD to 3 Gy???

Patients now have options and no longer need to deal with wholly unnecessary toxicity of photons for OA.

View attachment 393580

Man, I STILL think this is satire. This is like 'The Onion' level of satire in the Rad Onc world.