An evidence-based standard of care
Clinical Evidence
Low-dose radiation therapy for benign inflammatory and degenerative musculoskeletal conditions is supported by more than 20,000 cases documented in peer-reviewed literature spanning over a century of clinical use. European radiation oncology has employed LDRT for musculoskeletal indications since the early 1900s; Germany alone treats more than 15,000 osteoarthritis patients annually with LDRT as a covered, standardized therapy under national guidelines.
Reference Publications
Low-dose radiation therapy for benign orthopaedic conditions
Authors Mohiuddin, Ruffer, Siddiqi and Makda review LDRT for benign orthopedic conditions in JAAOS. This review article covers typical regimens of 0.5–1 Gy per fraction to 3–6 Gy total, along with the mechanistic basis of LDRT.
J Am Acad Orthop Surg. 2026.
Efficacy, safety and pain management of LDRT in osteoarthritis
In this systematic review and meta-analysis, Hammadeh et al. pool the available trial data. This article represents the most current quantitative synthesis in the field, and is indexed in Scopus and Web of Science.
Rheumatol Int. 2025;45(9).
The use of low-dose radiation therapy in osteoarthritis: a review
In this Red Journal publication, authors Dove, Cmelak, Darrow et al. complete a comprehensive view of the existing LDRT evidence for osteoarthritis.
Int J Radiat Oncol Biol Phys. 2022;114(2):203–220.
References
Additional Clinical Publications
- Mohiuddin MM, Ruffer JE, Siddiqi A, Makda J. Low-dose radiation therapy for benign orthopaedic conditions. J Am Acad Orthop Surg. 2026.
- Hammadeh BM, et al. Efficacy, safety, and pain management of low-dose radiation therapy in osteoarthritis: a comprehensive systematic review and meta-analysis. Rheumatol Int. 2025;45(9).
- Dove APH, Cmelak A, Darrow K, et al. The use of low-dose radiation therapy in osteoarthritis: a review. Int J Radiat Oncol Biol Phys. 2022;114(2):203–220.
- Minten MJM, Mahler E, den Broeder AA, Leer JWH, van den Ende CH. The efficacy and safety of low-dose radiotherapy on pain and functioning in patients with osteoarthritis: a systematic review. Rheumatol Int. 2016;36(1):133–142.
- Javadinia SA, et al. Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data. Int J Radiat Biol. 2021;97(10):1352–1367.
- Makarova MV, Valkov MY, Grjibovski AM. Effects of low-dosage radiotherapy for knee osteoarthritis on the incidence of knee arthroplasty: results of a randomized controlled trial with 9-year follow-up. Acta Biomed Sci. 2023;8(5):100–106.
- Fazilat-Panah D, et al. Effects of low dose rate radiotherapy on pain relief, performance score, and quality of life in patients with knee osteoarthritis; a double-blind sham-controlled randomized clinical trial. Int J Radiat Biol. 2025;101(5):541–548.
- Niewald M, et al. 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. Strahlenther Onkol. 2022;198(4):370–377.
- Niewald M, et al. ArthroRad trial: randomized multicenter single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis — final results after 12-month follow-up. Strahlenther Onkol. 2024;200(2):134–142.
- Rühle A, et al. Low-dose radiotherapy for painful osteoarthritis of the elderly: a multicenter analysis of 970 patients with 1,185 treated sites. Strahlenther Onkol. 2021;197(10):895–902.
- Minten MJM, Leseman-Hoogenboom MM, Kloppenburg M, et al. Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis Cartilage. 2018;26(10):1283–1290.
- Mahler EAM, Minten MJ, Leseman-Hoogenboom MM, et al. Effectiveness of low-dose radiation therapy on symptoms in patients with knee osteoarthritis: a randomised, double-blinded, sham-controlled trial. Ann Rheum Dis. 2019;78(1):83–90.
- van den Ende CHM, et al. Long-term efficacy of low-dose radiation therapy on symptoms in patients with knee and hand osteoarthritis: follow-up results of two parallel randomised, sham-controlled trials. Lancet Rheumatol. 2020;2(1):e42.
- Koneru BN, Shahrestani S, Javadinia SA. Heterogeneity in osteoarthritis radiotherapy: unresolved questions and the need for joint-specific evidence. Rheumatol Int. 2025.
- Kaltenborn A, Bulling E, Nitsche M, Carl UM, Hermann RM. The field size matters: low dose external beam radiotherapy for thumb carpometacarpal osteoarthritis. Strahlenther Onkol. 2016;192(8):582–588.
- Hermann RM, Trillmann A, Becker J-N, Kaltenborn A, Nitsche M, Ruettermann M. Prospective evaluation of low-dose external beam radiotherapy for painful trapeziometacarpal osteoarthritis (rhizarthrosis). Med Sci. 2021;9(4):66.
- Donaubauer A-J, et al. Low dose radiation therapy, particularly with 0.5 Gy, improves pain in degenerative joint disease of the fingers: results of a retrospective analysis. Int J Mol Sci. 2020;21(16):5854.
- Ott OJ, Hertel S, Gaipl US, Frey B, Schmidt M, Fietkau R. The Erlangen dose optimization trial for radiotherapy of benign painful shoulder syndrome. Strahlenther Onkol. 2014;190(4):394–398.
- Rogers S, et al. Prospective evaluation of changes in pain levels, quality of life and functionality after low dose radiotherapy for epicondylitis, plantar fasciitis, and finger osteoarthritis. Front Med (Lausanne). 2020;7:195.
- Hautmann MG, et al. Re-irradiation for osteoarthritis — retrospective analysis of 217 joints. Strahlenther Onkol. 2019;195(12):1060–1067.
- Keller S, et al. Efficacy of low-dose radiotherapy in painful gonarthritis: experiences from a retrospective East German bicenter study. Radiat Oncol. 2013;8(1):29.
- Koc BB, et al. Short-term pain reduction after low-dose radiotherapy in patients with severe osteoarthritis of the hip or knee joint: a cohort study and literature review. Eur J Orthop Surg Traumatol. 2019;29(4):843–847.
- Micke O, et al. Low-dose radiation therapy for benign painful skeletal disorders: the typical treatment for the elderly patient? Int J Radiat Oncol Biol Phys. 2017;98(4):958–963.
- Shah N, Bhandari R. Low-dose radiation therapy (LDRT) for osteoarthritis: a retrospective study of 94 patients and 136 joints treated. Adv Radiat Oncol. 2026:102050.
- Trott KR, Kamprad F. Radiobiological mechanisms of anti-inflammatory radiotherapy. Radiother Oncol. 1999;51(3):197–203.
- Rödel F, Keilholz L, Herrmann M, Sauer R, Hildebrandt G. Radiobiological mechanisms in inflammatory diseases of low-dose radiation therapy. Int J Radiat Biol. 2007;83(6):357–366.
- Donaubauer A-J, et al. Low dose radiation therapy induces long-lasting reduction of pain and immune modulations in the peripheral blood — interim analysis of the IMMO-LDRT01 trial. Front Immunol. 2021;12:740742.
- Weissmann T, et al. 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. Front Immunol. 2022;12:777792.
- Weissmann T, Rödel F, et al. Low-dose radiotherapy of osteoarthritis: from biological findings to clinical effects — challenges for future studies. Strahlenther Onkol. 2023;199(12):1164–1172.
- Ott OJ, et al. DEGRO guidelines for the radiotherapy of non-malignant disorders. Strahlenther Onkol. 2015;191(1):1–6.
- Seegenschmiedt MH, Micke O, Muecke R. Radiotherapy for non-malignant disorders: state of the art and update of the evidence-based practice guidelines. Br J Radiol. 2015;88(1051):20150080.
- McKeown SR, Hatfield P, Prestwich RJ, Shaffer RE, Taylor RE. Radiotherapy for benign disease: assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation. Br J Radiol. 2015;88:20150405.
- Brenner DJ, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA. 2003;100(24):13761–13766.