Managing Osteoarthritis With Low-Dose Radiotherapy

What the research shows

Studies have reported encouraging results in some patients, but the evidence remains mixed. Some studies have shown improvement in pain and function, while sham-controlled trials have not consistently demonstrated that radiotherapy works better than placebo treatment. Your radiation oncologist will discuss these uncertainties and whether treatment is reasonable for you.

Joints that may be considered

Low-dose radiotherapy may be considered for painful osteoarthritis affecting the following joints. The available evidence is not equally strong for every joint. Your physician will determine whether the location and cause of your pain are appropriate for treatment.

• Knee
• Ankle or foot
• Wrist, fingers or thumb
• Shoulder
• Hip
• Elbow
• Spine

Insurance coverage

Coverage depends on your diagnosis, insurance plan, local coverage rules and documentation of medical necessity. Medicare or private insurance coverage should not be assumed. The office will verify benefits and obtain authorization when required before treatment begins.

Before Treatment

You will meet with a radiation oncologist to review the location and severity of your symptoms, treatments you have already tried, your medical and surgical history, potential benefits, limitations and risks, and whether another treatment may be more appropriate.

Low-dose radiotherapy is generally considered when osteoarthritis symptoms continue despite other appropriate treatments or when conventional options are limited.

Treatment will be scheduled after any required insurance authorization is completed. Coverage and out-of-pocket costs vary, so contact your insurance plan or the treatment center’s financial team with questions.

Planning Session

Before treatment, you will have a CT simulation or another planning procedure.

• You will be placed in a comfortable, repeatable treatment position.
• The affected joint and nearby tissues will be mapped.
• Your physician will define the area to treat.
• The treatment team will create and verify an individualized radiation plan.

During Treatment

A typical course consists of six treatments delivered over approximately two weeks. One commonly studied schedule delivers a total dose of 3 Gy in six treatments. Your physician will prescribe the dose and schedule appropriate for you.

• The radiation therapist will position the affected joint.
• Imaging or other checks may be used to confirm the treatment area.
• Radiation delivery is painless.
• The appointment is usually brief, although positioning may take longer than the radiation itself.
• You will not see or feel the radiation.

Possible immediate effects

Most patients report few immediate side effects. Temporary skin irritation, swelling or a short-term increase in discomfort may occur. Tell the treatment team about any new or worsening symptoms.

You are not radioactive after treatment and cannot expose family members or other people to radiation.

After Treatment

Improvement may not occur immediately. Pain and function may change gradually over several weeks or months.

You may continue normal activities as tolerated unless another member of your healthcare team has given you restrictions. Low-dose radiotherapy does not replace exercise, physical therapy, weight management, medication, injections or orthopedic care when those treatments remain appropriate.

Available studies have generally reported few short-term treatment-related adverse effects. However, no medical treatment is completely risk-free, and long-term evidence—particularly from large randomized trials—is still developing. Your physician will discuss the small theoretical risk of radiation-related tissue injury or cancer and how it applies to your age, treatment area and health history.

Receiving low-dose radiotherapy does not automatically prevent future joint-replacement surgery. If surgery is later recommended, tell the surgeon that the joint previously received radiation.

Follow-Up

Your first follow-up visit will usually be scheduled approximately 6–12 weeks after treatment. Your care team will review changes in pain, joint movement and function, medication use, activity level and any treatment-related symptoms.

Some improvement may continue after the first follow-up. If the response is incomplete, a second treatment course may be considered several months later. This decision is individualized and should not be made until your physician has assessed the response to the first course.

When to Contact Your Care Team

Contact the treatment team if you develop any of the following symptoms.

• New or worsening swelling, redness or warmth
• Severe or rapidly increasing pain
• New weakness, numbness or loss of function
• Fever or signs of infection
• Any symptom that concerns you

Emergency care

Seek urgent or emergency care when directed, or call 911 if you believe you are experiencing a medical emergency.

Is Low-Dose Radiotherapy Right for You?

Low-dose radiotherapy may be an option for selected patients whose osteoarthritis remains painful despite other appropriate treatments. It is not guaranteed to relieve pain, stop arthritis progression or prevent surgery.

Your radiation oncologist will help you weigh the severity and location of your symptoms, other treatments you have tried, your age and general health, expected benefits and uncertainties, short- and long-term risks, and other available treatment options.