Low-Dose Radiation May Ease Osteoarthritis in People Who’ve Had Breast Cancer
A new clinical trial at UT MD Anderson Cancer Center will test using low-dose radiation therapy to ease osteoarthritis in the knees and hips in people who have arthritis flares as a side effect of immunotherapy treatment for breast cancer. Osteoarthritis, a type of arthritis, is a degenerative joint disease that causes bone and joint pain.
Doctors at UT MD Anderson, and at a number of other medical centers in the U.S. and around the world, have already been offering low-dose radiation to patients with osteoarthritis with promising results. But the new trial will be the first that’s studying the treatment in people who’ve had breast cancer.
Chidinma Anakwenze, MD, MPH, assistant professor of radiation oncology at UT MD Anderson Cancer Center in Texas, is leading the clinical trial. The results may show that low-dose radiation can help people with breast cancer stay on their treatments and improve their quality of life.
Why do the study?
Osteoarthritis is common among people with breast cancer. The condition can develop or worsen as a side effect of hormonal therapy (especially aromatase inhibitors), immunotherapy, or other breast cancer treatments. Worsening osteoarthritis symptoms lead some to stop taking their hormonal therapy or immunotherapy medicines, which can lead to a worse cancer outcome.
How best to treat osteoarthritis is a difficult problem to solve, in part because standard therapies for osteoarthritis don’t always work well or have other downsides. For example, steroid injections provide temporary relief but often need to be repeated, which can lead to joint damage. And steroids given in pill or IV form can make immunotherapy less effective because they suppress the immune system.
Anakwenze thinks low-dose radiation may benefit patients in the study in several ways.
“We think [low-dose radiation] gives us an opportunity to treat the arthritis, and maybe modulate the immune system in that local environment around the joint in a way that could prevent future flares, so they don’t have to stop taking their immunotherapy medicine,” says Anakwenze.
Low-dose radiation for osteoarthritis isn’t as well known or widely used in the U.S. as it is in some other countries. Anakwenze hopes the clinical trial will help raise awareness of the treatment and show that it should be offered more often to people with breast cancer in the U.S.
“It would be great if more people knew about this treatment option,” says Anakwenze. “We’re believers that it can help a lot of patients.”
How does low-dose radiation therapy work?
Low-dose radiation uses the same machines, and the same basic technique, as radiation therapy for cancer, but with much smaller doses of radiation. (The doses are 90–95% lower than those used to treat cancer). Researchers think that low-dose radiation reduces inflammation in the joints, and — unlike injections or joint replacement surgery — it’s noninvasive.
You receive the treatment at a radiation oncology clinic, where a large machine called a linear accelerator aims one or more beams of high-energy X-ray radiation at the affected joint. It’s usually given every other day for six sessions. If people don’t get relief from this first course of treatment, they may be offered an additional six sessions about three months later, possibly using a higher radiation dose.
Side effects are rare and tend to be minimal when they do occur; some people get mild skin irritation or temporary mild fatigue.
Who can get low-dose radiation for osteoarthritis?
Many people who have osteoarthritis are candidates for this treatment. It has been widely studied and used as a treatment for osteoarthritis in Europe for decades.
But in those who’ve had breast cancer, it’s typically only offered to certain patients. At the UT MD Anderson Cancer Center clinics, they include those who:
have mild-to-moderate osteoarthritis in their shoulders, knees, hips, wrists, or hands (the treatment isn’t being used to treat osteoarthritis in the spine yet)
haven’t gotten relief from common arthritis treatments like physical therapy and non-narcotic analgesics
haven’t had joint replacement surgery to treat their osteoarthritis
are age 50 or over
Because of the very small risk that the treatment could cause a second cancer to develop over time, it isn’t usually being offered to people younger than 50 who’ve had breast cancer. However, there can be some exceptions. For example, it may be offered to a younger person with metastatic breast cancer who hasn’t gotten relief from other therapies for arthritis.
How effective is low-dose radiation therapy?
Previous studies have shown that most people who receive low-dose radiation therapy for osteoarthritis report significant improvements in their pain and physical function. Anakwenze says that 70 to 80% of patients treated for mild-to-moderate osteoarthritis with low-dose radiation at UT MD Anderson Cancer Center have had a good response.
After starting treatment, pain tends to improve within a few weeks. For some people, it can even start improving within a few days. The effects can last anywhere from six months to two to three years.
People who have more severe osteoarthritis are more likely to need a repeat course of radiation about three months after the first one.
“Overall our patients have been really happy with the treatment and have had great outcomes,” says Anakwenze. “People who used to take five minutes to get up from their chair, can now get right up. One didn’t need to use a cane anymore. And another said: ‘You saved me from having to get a knee replacement.’”
How you can learn more about the clinical trial
Anakwenze’s clinical trial, called PRAISE-BC, will open for enrollment in January 2027 at several MD Anderson locations in the Houston area. For more info, email arthritisXRT@mdanderson.org.
Where else can you get low-dose radiation therapy and is it covered by insurance?
Low-dose radiation therapy for osteoarthritis is available at a growing number of radiation oncology clinics throughout the country and is usually covered by insurance if you have a doctor’s order for it and meet guidelines like the ones UT MD Anderson Cancer Center uses.
If you have osteoarthritis and are interested in trying low-dose radiation therapy, start by talking with your primary care doctor, radiation oncologist, medical oncologist, palliative care doctor, orthopedic surgeon, or the staff at a radiation oncology clinic in your area about where the treatment is offered and if it would be a good fit for you.