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Meta-Analysis
. 2025 May;201(5):483-494.
doi: 10.1007/s00066-024-02329-0. Epub 2024 Dec 4.

Comparative effectiveness of kilo- and megavoltage energies in low-dose radiotherapy for painful degenerative musculoskeletal diseases: a systematic review and meta-analysis

Aram Kim  1 , Jeanny Kwon  1 , Ji Young Kim  2 , Byoung Hyuck Kim  3
Affiliations
Meta-Analysis

Comparative effectiveness of kilo- and megavoltage energies in low-dose radiotherapy for painful degenerative musculoskeletal diseases: a systematic review and meta-analysis

Aram Kim et al. Strahlenther Onkol. 2025 May.

Abstract

Purpose: This study aimed to assess the impact of different energy levels on the effectiveness of low-dose radiotherapy (LDRT) for treating painful degenerative musculoskeletal diseases, as comparative efficacy data are currently lacking.

Methods: A systematic review was conducted in PubMed, Embase, and the Cochrane Library databases to identify studies with response information on the energy used (kilovoltage [kV] vs. megavoltage [MV]). The primary endpoint was the overall response rate (ORR), and the secondary endpoint was the complete response rate (CRR). Exploratory subgroup analyses included treatment site, study period, study design, country, and dose per fraction.

Results: A total of 33 studies involving 12,143 patients were analyzed. Short-term follow-up (up to 6 months) showed a pooled ORR of 64% (95% CI 46-78%) for kV and of 62% (95% CI 54-70%) for MV. Long-term follow-up (at least 12 months) revealed a pooled ORR of 85% (95% CI 65-95%) for kV and of 69% (95% CI 62-75%) for MV. Subgroup analysis indicated no significant differences in ORR for energy level stratified by treatment site and other factors. Regarding dose per fraction (0.5 Gy vs. 1.0 Gy), comparable ORRs were demonstrated between the two energies. No clinical side effects were noted.

Conclusion: This meta-analysis suggests that the known effectiveness of LDRT in painful degenerative musculoskeletal disease may not depend on the energy used. Additional studies using standardized evaluation methods are warranted to establish consistency and enhance the comprehensiveness of research. Further research is also needed to explore treatment modality selection considering disease-specific biology.

Keywords: Chronic pain; Joint diseases; Low-dose; Osteoarthritis; Pain management; Radiotherapy.

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Conflict of interest statement

Conflict of interest: A. Kim, J. Kwon, J.Y. Kim, and B.H. Kim declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection process
Fig. 2
Fig. 2
Forest plot of overall response rate in short-term follow-up. a kV and b MV. CI confidence interval
Fig. 3
Fig. 3
Forest plot of overall response rate in long-term follow-up. a kV and b MV. CI confidence interval
Fig. 4
Fig. 4
Subgroup analysis of overall response rate: a short-term follow-up and b long-term follow-up in kV vs. MV. Fx fraction, CI confidence interval, ORR overall response rate
See this image and copyright information in PMC

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