![]() In external radiation treatment, these advances include intensity-modulated radiotherapy, as well as novel technologies like MR Linac. However, recent advances in both external and internal radiation techniques make these therapies potentially more accurate. Ionizing radiation therapies of the past, like x-ray- or radioactive iodine therapy, damaged a large area around the region of interest. Interestingly, like in these previously mentioned oncological conditions, ionizing radiation may play a role in the treatment of infectious diseases. The 5-year mortality of PJI even surpasses that of most forms of prostate-, breast- and thyroid cancer. In this regard, PJI patients are not dissimilar to oncology patients, with comparably high morbidity- and mortality rates. In addition, the (often) elderly PJI population usually has multiple comorbidities, which necessitates multimodality treatment. Despite this intensive treatment, outcomes are still unpredictable. Ĭurrently, patients with PJI get prolonged antibiotic treatment, occasionally combined with multiple irrigation and debridement surgeries with- or without implant exchange to combat the infection. This hinders the host immune system, but more importantly, bacteria in a biofilm are mostly in a metabolic inactive or dormant state and therefore not susceptible to most antibiotics. PJI is difficult to treat as bacteria form a biofilm on the prosthetic material. Total joint replacements are a common, last-resort treatment for degenerative joint disease, but 1–4% of patients develop a periprosthetic joint infection (PJI). The field of orthopedic surgery is in dire need of novel treatments. However, the war against infections is still ongoing and widespread use and misuse of antibiotics have led to the emergence of antibiotic-resistant bacteria, while the discovery and development of new antibiotics is rapidly declining. In the 1940s, radiation treatment slowly became obsolete with the discovery and availability of antibiotics. Its usefulness in diagnosis and oncological treatment is undisputed, but in the early twentieth century, radiation was commonly employed to treat infections, especially due to a lack of alternative treatments and limited knowledge of possible side effects. However, potential risks involving radiation treatment must be considered in each individual patient.įor more than a century, radiation has been used as a treatment modality for a wide range of diseases. The novel prospects of radiation treatment strategies against planktonic and biofilm-related microbial infections seem feasible and are worth investigating further. Internal radiation using alpha and beta emitting radionuclides show great promise in treating fungal and bacterial infections when combined with selective targeting through antibodies, thus minimizing possible collateral damage to healthy tissue. ![]() In some cases, external radiation therapy decreased the mortality significantly but long-term follow-up of the patients was often not performed so long term radiation effects, as well as potential increased risk of malignancies could not be investigated. In the pre-antibiotic era, high mortality rates were seen in different infections such as pneumonia, gas gangrene and otitis media. The main advantages, disadvantages, limitations, and implications of radiation treatment for infections were discussed. ![]() Due to the large number of studies, several topics were chosen. A total of 216 potentially relevant full-text publications were independently reviewed, of which 182 focused on external radiation and 34 on internal radiation. MethodsĪ systematic search strategy was designed to select studies that used radiation as treatment for bacterial or fungal infections. This review aims to provide a historical overview and future perspective of radiation therapy in infectious diseases with a focus on orthopedic infections. One candidate that has been used extensively in the past, is the use of ionizing radiation. Alternative treatment modalities are needed to treat these types of infections in the future. This has made certain implant-associated infections such as periprosthetic joint infections, where a biofilm is formed, very difficult to treat. Widespread use and misuse of antibiotics have led to a dramatic increase in the emergence of antibiotic resistant bacteria, while the discovery and development of new antibiotics is declining.
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