Three-dimensional treatment planning and target volume definition of tendinitis and bursitis - Consensus statement of the International Benign Target Volume Group (IBTVG).

Abstract

Musculoskeletal disorders, particularly tendinitis and bursitis, are major contributors to global disability and healthcare burden. Low-dose radiotherapy (LDRT) has emerged as a promising treatment for refractory cases, demonstrating anti-inflammatory and anti-proliferative effects, especially in inflammatory conditions. However, the lack of standardized treatment volumes hampers reproducibility, radiation safety, and broader clinical adoption. To address this gap, an international panel of experts applied the Delphi method to develop consensus-based target volumes for LDRT in common indications such as shoulder bursitis, lateral elbow tendinitis, trochanteric pain syndrome, achilles tendinitis, and plantar fasciitis. Utilizing a standardized CT-based homunculus, target volumes were delineated in a 3D Cartesian coordinate system to enable precise definition of gross tumor volume (GTV), clinical target volume (CTV), and planning target volume (PTV). Additionally, associated ICD-10 codes were defined to facilitate clinical documentation, billing, and future research. This structured approach provides a foundation for consistent treatment protocols, improved radiation protection, and future prospective trials to refine LDRT application in benign musculoskeletal conditions.