This was particularly the case with the research of Branham, who not only replicated the earlier research of Schulz, but clarified the dose-time response relationship. This was observed initially over a century ago by Townsend and extended to other biological models and endpoints in the subsequent decades. Key questions are why is the hormetic dose-response modest, and what are its implications? Considerable evidence indicates that hormetic dose-responses represent a modest overcompensation to a disruption in homeostasis. Superficial (100- to 250-kV) x-rays, or 6- to 12-meV electrons with bolus, may be used, with appropriate shielding for the glans and testes.Įdward Calabrese, in Pharmacology, 2009 5.2.3.1 The Hormesis Stimulation: Direct or Compensatory Response to Damage? Doses of 8 to 12 Gy, in 2 to 3 Gy fractions delivered two to three times per week to the penis, are adequate. In summary, radiation treatment is a well-tolerated and noninvasive form of therapy for Peyronie disease, especially when pain is the dominant symptom. 143Ī recent European survey indicated that radiotherapy was still being used in approximately 20% of institutions, and confirmed that palliation of pain was obtained in 80% of patients.
The glans should be shielded if it is uninvolved with plaque. 3įailure of other therapies does not preclude a response to radiotherapy, and failure of radiotherapy does not preclude the use of other modalities. Treatment is painless, localized to the penis, without systemic side effects, and completed in 1 to 2 weeks, with only rare complications if external-beam radiotherapy is used. Improvement of curvature in approximately 57% of patients 2 Palliation of pain in approximately 80% of patients ▪ĭecreased size of plaque in approximately 61% of patients ▪ There is a high rate of success when compared with other treatments: ▪ Indications and rationale for radiotherapy, as reviewed and summarized by Mira and colleagues, 141, 142 include the following: 1 Initially, radium molds were frequently used however, external-beam radiotherapy has been used virtually exclusively in recent decades. Radiotherapy has been used as a treatment for Peyronie disease since at least the 1920s. A comparison of treatments is confounded by the fact that the condition is self-limited in many cases, with as many as 50% of cases resolving spontaneously within 12 to 18 months. 137, 138 Various therapeutic modalities have been used in the management of this disorder, including steroid injections, vitamin E, intralesional verapamil injections, surgery, and radiation therapy. Pathologically, the disorder is characterized in its early stages (<3 months’ duration) by an inflammatory cellular infiltrate and in its later stages by the development of fibrous connective tissue and rarely even ossification. Although the disorder is not life-threatening, it can have a significant negative effect on quality of life. The disorder is characterized by penile curvature during erection and the presence of penile plaques or induration, often leading to pain on erection or during intercourse or erectile dyfunction. The prevalence of the disorder has been estimated at between 3.2% to 8.9%, and it is characterized by the development of penile plaques arising from fibrosis of the corpus cavernosum. Peyronie disease has been described since the 18th century, but the pathophysiology and natural history are still unclear. Dutton MD, MPH, in Leibel and Phillips Textbook of Radiation Oncology (Third Edition), 2010 Peyronie Disease
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