Radiotherapy in the treatment of benign inflammatory and proliferative conditions

The ICON clinical team has endorsed a new Royal College of Radiologists’ review document on the appropriate role of radiotherapy in the treatment of benign inflammatory and proliferative conditions.

The ICON clinical team would like to draw your attention to this excellent review document on the appropriate role of radiotherapy (RT) in the treatment of benign inflammatory and proliferative conditions, which was published by the Royal College of Radiologists’ Faculty of Clinical Oncology. The review stems from a need that was identified in the UK for a more standardised approach to the use of radiotherapy to treat these various conditions. This is an approach ICON endorses as applicable to South Africa, especially where we wish to give our patients evidence-based treatment that may be justified to the funders.

Information on the current practice followed in the UK was gleaned via a survey sent to all radiotherapy centres in the UK, which revealed a wide discrepancy in the numbers of patients treated in different departments, as well as a wide variation in dose/fractionation.

This document – that may be considered a handbook – uses a mixture of reference sources including meta-analyses and published data, as well as other European recommendations.  Conditions excluded from this review were thyrotoxicosis, phaeochromocytoma, desmoid tumour, craniopharyngioma and pituitary adenoma, among others. These excluded conditions are primarily managed following clear protocols or guidelines, or are managed by MDTs in the UK.

It was noted that there has been a decline in the use of RT for benign disease in the UK, but it is still commonly used in Germany. The German Working Group on Radiotherapy for Benign Disease consensus guidelines and the ESTRO 2007 workshop on RT in benign disease were also referenced in the establishment of these recommendations.

The sections dealing with normal tissue responses to the doses of RT used for benign disease, as well as one on secondary malignancy or radiation induced cancers (RIC), are worthwhile reviews in their own right and all radiation and clinical oncologists would benefit from reviewing them. What this document highlights is, while the risk of RIC is low in most cases, it should always be discussed clearly with patients.  For this reason, these patients should be followed up over a long period of time in order to detect late toxicity as soon as possible.

Sections on head and neck paragangliomas, benign thyroid eye disease, pterygium, Dupuytren’s disease, Peyronies, aneurysmal bone cyst, vertebral haemangioma, keloids and RT to prevent gynaecomastia in prostate cancer patients on hormonal therapy are only some of the conditions covered. Each well-referenced disease entity comes with a summary of recommendations as to where RT fits into the treatment of the disease under discussion, as well as other pointers, evidence of efficacy and levels of evidence, as well as recommended dose fractionation/schedules.  For example, in hormone induced gynaecomastia, they feel that RT may be used both as prevention against, and palliation of, gynaecomastia/mastalgia, with a single dose of 10-12 Gray electrons or superficial beam RT.

The ICON clinical team would highly recommend the use of this document, both as a reference tool and as guidelines for the management of these conditions. The issue of non-malignant conditions being covered by funders remains a difficult one, but we in the ICON clinical team will do our best to assist the Network on a patient-by-patient basis. This excellent document will be a useful reference document.