Low-Dose Radiotherapy for Benign Diseases

Low-dose radiotherapy (LD-RT) has emerged as a well-established, non-invasive treatment modality for a variety of benign inflammatory and degenerative conditions. Delivered in single fractions of approximately 0.3–1.0 Gy to cumulative doses rarely exceeding 6 Gy, LD-RT exploits anti-inflammatory and analgesic effects while minimising the risks associated with higher-dose oncological regimens. Clinical experience in several European countries dates back decades, with consensus guidelines advocating its use for painful osteoarthritis, enthesopathies, bursitis and tendinopathies when conventional therapies have failed. At the cellular level, LD-RT modulates cytokine release, adhesion molecule expression and immune cell recruitment, and exerts favourable effects on osteoclast and osteoblast activity to reduce bone resorption and support tissue repair. Non-linear dose–response relationships often reveal an optimum effect around 0.5 Gy per fraction, underscoring the need for precise fractionation. The overall safety profile is excellent, with negligible acute toxicity and no evidence of long-term harm in healthy tissues when applied according to established protocols. Growing interest centres on mechanistic insights into systemic immunomodulation, the temporal onset of analgesia and integration with other conservative measures. The global significance of LD-RT lies in its cost-effectiveness, reproducibility and the potential to restore function and quality of life in ageing populations burdened by chronic musculoskeletal pain.

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Low-Dose Radiotherapy for Benign Diseases publication trend

The graph below shows the total number of articles in low-dose radiotherapy for benign diseases across all publications each year (not limited to Nature Index journals).

Technical terms

Low-dose radiotherapy (LD-RT): Application of ionising radiation at low exposure levels (0.3–1.0 Gy per fraction) to benign inflammatory or degenerative disorders.

Gray (Gy): Unit of absorbed radiation dose, defined as one joule of energy deposited per kilogram of tissue.

Visual analogue scale (VAS): A unidimensional pain assessment tool, typically ranging from 0 (no pain) to 10 (worst imaginable pain).

Cytokine: Soluble protein mediators released by immune cells that regulate inflammation, cell proliferation and tissue repair.

Osteoclast: Multinucleated cell responsible for bone resorption and turnover.

Osteoblast: Bone-forming cell that synthesises extracellular matrix and facilitates mineralisation.

Immunomodulation: Alteration of the immune response, often via changes in cell populations or cytokine profiles, to achieve therapeutic benefit.

References

1. Low-Dose Radiotherapy Ameliorates Advanced Arthritis in hTNF-α tg Mice by Particularly Positively Impacting on Bone Metabolism. Frontiers in Immunology (2018).
2. Radiotherapy for non-malignant disorders: state of the art and update of the evidence-based practice guidelines. British Journal of Radiology (2015).
3. Immunomodulatory Properties and Molecular Effects in Inflammatory Diseases of Low-Dose X-Irradiation. Frontiers in Oncology (2012).
4. Low-Dose Radiotherapy Has No Harmful Effects on Key Cells of Healthy Non-Inflamed Joints. International Journal of Molecular Sciences (2018).
5. Prospective Evaluation of Changes in Pain Levels, Quality of Life and Functionality After Low Dose Radiotherapy for Epicondylitis, Plantar Fasciitis, and Finger Osteoarthritis. Frontiers in Medicine (2020).
6. ArthroRad trial: multicentric prospective and randomized single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis depending on the dose—results after 3 months’ follow-up. Strahlentherapie und Onkologie (2021).
7. Low-Dose Radiotherapy Leads to a Systemic Anti-Inflammatory Shift in the Pre-Clinical K/BxN Serum Transfer Model and Reduces Osteoarthritic Pain in Patients. Frontiers in Immunology (2022).