Wednesday, 10 May 2017

Review of a review on RT for benign conditions

http://journal.frontiersin.org/article/10.3389/fimmu.2017.00519/full

From my point of view I just wanted to take some notes from it. Straight off in the abstract is a key point that many “specialist” on these conditions don’t realise, and I quote “For decades, low- and moderate-dose radiation therapy (RT) has been shown to exert a beneficial therapeutic effect in a multitude of non-malignant conditions”. Radiotherapy is not new and it does not have a big impact on cancer risk. If you didn’t know that and take it away from the paper then that is a great start. By above point is acknowledged in the introduction “the use of RT in the management of hyper proliferative non-cancerous disorders is controversially discussed and inadequately recognized by doctors from disciplines others than RT”.

The usual risk factors are listed and DD favouring men, personally I am still not convinced that LD does, especially given the results of the survey (2015) and the composition of all the online groups but that is not scientific to say the least.

They highlight that for DD radiotherapy has been shown to be more effective than no treatment (21gy or 30gy protocol) in terms of progression with follow up averaging 8 years. We know that in a lot of patients RT is the way to go and they highlight that there is a paper showing this (that is the point of a review after all). As a Ledderhose patient the information presented on RT for LD is good - 33% remission, 54.5% decrease in nodules, 70% decrease in pain. Better results than pretty much every other treatment. I was not aware of the impressive results for use on Keloids but they are there.

The mechanism through which RT works is briefly discussed and it covers both the DNA damage pathways (my old expertise that I have covered before) and newer studies showing that there are likely DNA damage independent impacts as well. I am Interested in looking more into that.   

I find their thoughts on cancer risk interesting “estimation of cancer risk after radiation treatment for benign diseases is challenging, but for current clinical protocols regarded to be small especially for older patients (36). By contrast, the balance of risk and benefit has to be considered carefully for younger patients, and children should not be subjected to LD-RT at all.” For me as a younger patient the risk reward was well worth it, but then I don’t have cancer and if I do get it the likelihood it was caused by the RT is minimal

They say, as best I can understand, that the different stages of DD have different sensitivities to radiotherapy in the different stages due to differentiation of the cells and different levels of proliferation. Certainly I am aware that the more proliferative a cell the more sensitive it is to RT. I also think they state that it is possible that RT may increase TFG-B1 transcription and this could result in a decrease in proliferation and ECM deposition.

Finally there is the conclusion and future perspectives section … RT works and probably does so for a variety of reasons. It is a relatively low cost, low risk and effective treatment. I think there is also the implication that the dose used could be lowered, or at least a lower dose tested perhaps in combination with anti-inflammatory drugs, if comparable results are found then it will only increase the growing acceptance of RT as a treatment option.