LoRD-KNeA trial on Low Does Radiotherapy as a potential treatment for knee osteoarthritis
The International Organisation for Radiotherapy for Benign Conditions (IORBC) welcomes a significant advancement in osteoarthritis (OA) treatment research with the prospective LoRD-KNeA trial by Byoung Hyuck Kim and colleagues, published in the BMJ Open.
The trial will represent a pioneering effort in exploring low-dose radiation therapy (LDRT) as a potential treatment for knee OA.
LDRT for OA has been performed for several decades. However, as noted by the authors, the ‘supporting evidence from randomised studies using modern methodologies is lacking’. At the IORBC, we consider this a key issue — with knee osteoarthritis presenting a major health concern that can lead to disability.
The prospective LoRD-KNeA trial, registered on clinicaltrials.gov, is a multicentre, single-blinded, sham-controlled study. It aims to compare the effectiveness of LDRT with sham radiation therapy in managing knee OA symptoms, involving three academic hospitals in Korea, and targeting patients aged 60-85. Key inclusion criteria are primary knee OA with Kellgren-Lawrence grade 2–3 and visual analogue scale 50–90 when walking at the baseline.
A primary focus of this prospective trial is its emphasis on minimising the influence of pain medication on results. Participants are required to discontinue all pain medications except for emergency use. This approach addresses a critical bias observed in previous studies, where the uncontrolled use of analgesics clouded the outcomes.
The trial involves two experimental groups receiving different dosages of LDRT (0.3 Gy/6 fractions and 3 Gy/6 fractions) and a control group receiving sham radiation. The primary endpoint is the rate of responders at 4 months post-treatment, evaluated according to the OMERACT-OARSI criteria. Secondary endpoints include changes in pain, stiffness, physical function, and serum inflammatory markers.
Safety is a paramount concern, with potential toxicities being closely monitored. The study’s design also considers the need for future trials to optimise LDRT dosages and broaden its application in OA treatment.
The LoRD-KNeA trial represents another major step in the worldwide adoption of LDRT as a viable, non-invasive treatment option for knee osteoarthritis, with the potential to improve patient outcomes and reduce the socioeconomic burden of this debilitating condition.
The IORBC looks forward to the results being published.
Read the full article here:
Authors:
Byoung Hyuck Kim, Kichul Shin, Min Jung Kim, Hak Jae Kim, Du Hyun Ro, Joon Ho Wang, Dae-Hee Lee, Dong Hyun Kim, Jiyu Sun, Ji Hyun Lee, Ji Young Kim, Eun-Hee Hong, Seong-Jun Cho, Hyuk-Soo Han, Won Park