Low-Dose Radiation Therapy Gains Traction in US, With Hirsch Sudhir Matani, MD

Low-dose radiation therapy (LDRT) is emerging in US clinical practice as a noninvasive option for chronic musculoskeletal pain, particularly osteoarthritis and other degenerative or inflammatory conditions, with early clinical experience suggesting meaningful pain reduction and a favorable safety profile in appropriately selected patients.

In an interview with HCPLive, Hirsch Sudhir Matani, MD, radiation oncologist at Keck Medicine of USC, described LDRT as a long-established treatment in Europe that is beginning to gain renewed interest in the United States as awareness increases and supporting clinical data continue to accumulate. Adoption in the United States has historically been limited, reflecting differences in training and referral patterns.

“I guess the main reason why it hasn't been adopted as broadly [in the US] is the landscape of healthcare and the differences that are our systems compared with Europe,” Matani said.

Matani noted that increasing engagement from professional societies, including the American Society for Radiation Oncology (ASTRO), has contributed to renewed discussion regarding the role of radiation therapy in nonmalignant disease states.¹ As clinicians reassess nonpharmacologic options for chronic pain, LDRT is being reconsidered within multidisciplinary care models.

A key distinction between LDRT and oncologic radiation therapy lies in dose and biologic effect. Cancer treatment commonly involves cumulative doses in the range of approximately 50 to 80 Gy, depending on tumor type and treatment intent. In contrast, LDRT for benign disease typically uses low single-digit gray doses, often around 3 Gy, delivered in limited fractions. At these lower doses, radiation is thought to exert anti-inflammatory rather than cytotoxic effects.

Clinically, LDRT is most commonly applied in conditions such as osteoarthritis, plantar fasciitis, Dupuytren contracture, and Ledderhose disease. Patient selection generally focuses on individuals with persistent symptoms despite conservative management, often defined as ≥ 6 months of ongoing pain that has not responded adequately to nonsteroidal anti-inflammatory drugs, physical therapy, or intra-articular injections.

Across published European experience and institutional reports, approximately 60% to 80% of patients experience some degree of pain improvement following LDRT, ranging from partial relief to more substantial functional improvement.2 Research has shown that pain relief has lasted up to 2 years.3 Available evidence suggests a low incidence of adverse effects with low-dose LDRT.

Standard care for osteoarthritis and related conditions typically includes pharmacologic therapies such as NSAIDs or corticosteroids, physical therapy, and, when appropriate, surgical referral.

“We generally treat patients [with LDRT) who are either not surgical candidates or don't want surgery, and they've tried some other interventions that haven't really worked,” Matani said. “I could see that evolving over as we in the US…get more used to using low-dose radiation and as primary care providers and other doctors see that it works with limited side effects.”

Reported disclosures for Matani include Icotec Medical Inc. and GlaxoSmithKline, LLC.

References

1. Low-dose radiation therapy offers substantial relief to people with painful knee osteoarthritis - American Society for Radiation Oncology (ASTRO). ASTRO. Published September 28, 2025. https://www.astro.org/news-and-publications/news-and-media-center/news-releases/2025/low-dose-radiation-therapy-offers-substantial-relief-to-people-with-painful-knee-osteoarthritis

2. Hoveidaei A, Karimi M, Salmannezhad A, Tavakoli Y, Taghavi SP, Hoveidaei AH. Low-dose Radiation Therapy (LDRT) in Managing Osteoarthritis: A Comprehensive Review. Curr Ther Res Clin Exp. 2025;102:100777. Published 2025 Feb 12. doi:10.1016/j.curtheres.2025.100777

3. Low-dose Radiation Therapy | Texas Oncology. Texasoncology.com. Published 2026. Accessed April 29, 2026. https://www.texasoncology.com/cancer-care/low-dose-radiation-therapy