In March 2024, radiation oncologist Dr. Sanjay Mehta faced persistent pain from Achilles tendinitis in his left ankle. After steroid and platelet-rich plasma (PRP) injections brought relief, he developed the same condition in his right ankle just three months later.
This time, however, Mehta turned to an unconventional option—low-dose radiation therapy (LDRT), a treatment he had recently begun offering to patients with inflammatory conditions. Following six self-administered low-dose X-ray sessions, covered by insurance, Mehta reported being pain-free and expanded the therapy’s availability to more of his patients.
“The main surprise was … why didn’t I think of this earlier?” Mehta said.
Mehta is part of a growing contingent of U.S. radiation oncologists using LDRT to address benign inflammatory conditions such as arthritis, plantar fasciitis, Peyronie’s disease, and keloids. The American Society for Radiation Oncology (ASTRO) highlighted LDRT’s use in non-cancerous conditions in its spring 2024 newsletter, helping drive renewed interest. Unlike cancer treatments, LDRT delivers significantly lower radiation levels—about the equivalent of several CT scans over six sessions—to target and suppress inflammatory cells.
Though its use faded in the 20th century with the rise of anti-inflammatory medications and radiation concerns, LDRT has remained a common practice in Europe. Germany, for instance, published national guidelines for nonmalignant uses of radiotherapy in 2000. In the U.S., interest in such applications has slowly reemerged in the last decade.
Dr. Gopal Bajaj, the musculoskeletal lead for ASTRO’s task force on non-oncologic diseases, first explored LDRT about ten years ago when a patient with Dupuytren’s contracture—a condition where the hand’s connective tissue thickens, causing fingers to curl—requested it. After studying German literature on the subject, Bajaj treated the patient successfully and has since treated nearly 800 more from across the country.
“Most patients we see with Dupuytren’s are actively progressing when they begin treatment, and after radiation therapy, fewer than 5 to 8 percent continue to worsen,” Bajaj said.
LDRT is also showing promise for inflammatory conditions like osteoarthritis, plantar fasciitis, and tendinopathy. Bajaj reports 60 to 80 percent of patients experience symptom relief.
A recent Department of Veterans Affairs review of 48 LDRT studies found mixed evidence on its effectiveness but concluded the therapy may be worth considering when conventional treatments fail. Both Mehta and Bajaj believe clinical outcomes are outpacing the current research.
How It Works
Inflammation triggered by injury or trauma leads white blood cells called macrophages to release pro-inflammatory chemicals. LDRT suppresses these macrophages, helping reduce pain and swelling, Mehta explained. It’s most effective in conditions where inflammation is central, such as tendinitis or plantar fasciitis. Relief can be immediate or take several weeks. In Mehta’s case, it took six to eight weeks for his Achilles tendon to improve.
While corticosteroid injections may act faster, Mehta notes that LDRT results tend to last longer and pose less risk of weakening tendons, which repeated steroid use can cause.
Still, Bajaj points out there’s a “sweet spot” for LDRT: it may be less effective in late-stage conditions like bone-on-bone arthritis or autoimmune diseases such as ankylosing spondylitis.
Balancing Risks and Benefits
Not all radiation oncologists are embracing the therapy. At Florida’s Moffitt Cancer Center, Dr. Jose Penagaricano faced initial resistance when he began treating osteoarthritis and Dupuytren’s contracture due to concerns that it could detract from time and resources for cancer patients. However, with limited consultations, the impact has been minimal, he said.
A more significant concern is cumulative radiation exposure. The Environmental Protection Agency warns that even low-dose exposure carries a small increased cancer risk over time. However, Dr. David Brenner, director of the Center for Radiological Research at Columbia University, notes that the areas commonly treated—hands, feet, and knees—contain fewer rapidly dividing cells and thus pose a lower risk.
A 2015 study in the British Journal of Radiology supports this, finding minimal cancer risk associated with LDRT, especially in older patients. However, the study urged caution in younger individuals due to potential long-term effects.
As a result, radiation specialists typically reserve LDRT for patients over 40. “With these low doses of radiation that we use for arthritis and tendinitis, there’s been nothing described in the literature for over a hundred years,” Mehta emphasized.
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