Radiation therapy for benign diseases: Patterns of care study in Germany

Background: Radiotherapy of benign diseases is controversial and rarely app lied in Anglo-American countries, whereas in other parts of the world it is commonly practiced for several benign disorders. Similar to a European sur vey, a patterns of care study was conducted in Germany. Method: Using a mailed questionnaire, radiation equipment, treatment indica tion, number of patients, and treatment concepts were assessed in 1994, 199 5, and 1996 in 134 of 152 German institutions (88%): 22 in East and 112 in West Germany; 30 in university hospitals and 104 in community hospitals. Av erage numbers of each institution and of all institutions were analyzed for frequencies and ratios between regions and among institutions. Radiation t reatment concepts were analyzed. Results: A mean of 2 (range 1-7) megavoltage and 1.4 (range 0-4) orthovolta ge units were available per institution; 32 institutions (24%) had no ortho voltage equipment. A mean of 20,082 patients were treated annually: 456 (2% ) for inflammatory diseases (221 hidradenitis, 78 local infection, 23 parot itis; 134 not specified) 12,600 (63%) for degenerative diseases (2711 perit endinitis humeroscapularis, 1555 epicondylitis humeri; 1382 plantar/dorsal heel spur; 2434 degenerative osteoarthritis; 4518 not specified); 927 (5%) for hyperproliferative diseases (146 Dupuytren's contracture, 382 keloids; 155 Peyronie's disease; 244 not specified); 1210 (6%) for functional disord ers (853 Graves' orbitopathy; 357 not specified); and 4889 (24%) for other disorders (e.g., 3680 heterotopic ossification prophylaxis). In univariate analysis, there were geographic (West vs. East Germany) differences in usin g radiation therapy (RT) for inflammatory and degenerative disorders, and i nstitutional differences (university versus community hospitals) in using R T for hyperproliferative and functional disorders (p < 0.05). The prescribe d dose concepts were mostly in the low dose range, <10 Gy but varied widely and inconsistently within geographic regions and institutions. Conclusion: Radiation therapy is a well-accepted and frequently practiced t reatment for several benign diseases in Germany; however, there are signifi cant geographic and institutional differences. As the number of orthovoltag e units decreases, an increasing patient load will demand more megavoltage units, which may compromise the cost-effectiveness of this treatment. Only 4% of all clinical institutions have been involved in controlled clinical t rials. To maintain a high level of RT service to other disciplines, RT trea tment guidelines, quality control, and continuing medical education are req uired. (C) 2000 Elsevier Science Inc.