Scott Webb (Host): Osteoarthritis is very common, and my guest today is here to discuss a revolutionary treatment option that involves low-dose radiation therapy for osteoarthritis and other common conditions. I'm joined today by Dr. Sandeep Bhave. He's a board-certified radiation oncologist practicing at Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you on today. As I was mentioning, we're going to talk about osteoarthritis, and I have that and lots of folks have that. But you're here to talk about radiation therapy for osteoarthritis, and that's interesting to me. That piqued my interest. So, let's just kind of start with the basics.

Like, what is radiation therapy? I think most people probably associate it with cancer treatment, but how does low-dose radiation therapy differ from maybe the cancer treatment, and how is it helping folks with osteoarthritis?

Dr. Sandeep Bhave: Briefly, to just start about radiation therapy, radiation therapy uses high-energy X-rays. And it's used to treat a wide range of medical conditions. Most commonly, it's used in cancer. About 70% of patients receive radiation during some point of their treatment. And usually, it's used for curative intent, but it also is used for helping with symptoms caused by advanced cancer.

Low-dose radiation therapy is very different. Instead of delivering doses designed to destroy cancer cells, low-dose radiation uses a small fraction of the radiation typically prescribed for cancer, about 3% of the standard radiation dose. At these much lower doses, radiation has been shown to be highly effective for a variety of musculoskeletal conditions, including osteoarthritis.

Host: Yeah. Yeah, it's interesting and it's why we have experts because, you know, I think, "Radiation, how could that possibly help folks with osteoarthritis?" But we get a sense that it can. And I was doing some reading and reading that it is being used to treat osteoarthritis. But maybe before we get too far along here, what is osteoarthritis for folks who don't know and aren't suffering from it like me? And besides osteoarthritis, are there some other conditions that low-dose radiation can help with?

Dr. Sandeep Bhave: Osteoarthritis is the most common cause of arthritis and affects many millions of adults in the United States. It occurs when the articular cartilage, which is the smooth protective tissue that covers the ends of the bones in a joint, gradually breaks down over time. As the condition progresses, changes happen in the underlying bone, including development of spurs and cysts. This leads to joint pain, stiffness, swelling, difficulty moving, and making activities of daily living more challenging.

With regards to low-dose radiation, not only can it be used for osteoarthritis, but there are numerous amount of musculoskeletal conditions that can be helped with low-dose radiation to decrease pain and inflammation. These include plantar fasciitis, tennis elbow, hip bursitis, otherwise known as greater trochanteric pain syndrome.

Host: Yeah, that checks out. And you're going through that little laundry list of things that low-dose can help with, and I'm like, "Yeah, I got a couple of those." So, maybe it'll be one-stop shopping for me and maybe other patients. But give us a sense, Doctor, like how does this work? How does low-dose radiation treat a patient's pain?

Dr. Sandeep Bhave: Sure. So, great question. At low doses used for musculoskeletal conditions, radiation acts less like cancer treatment and more like a powerful anti-inflammatory therapy. It helps calm inflammation by reducing the amount of inflammatory white blood cells that enter the joint. Low-dose radiation also decreases the release of inflammatory signals called cytokines and helps eliminate activated inflammatory cells. This results in less inflammation, which causes reduced pain and hopefully improved mobility.

Host: Right. Yeah. That's the dream. That's the end goal, of course. Doctor, are there some folks that are just better candidates for low-dose radiation therapy?

Dr. Sandeep Bhave: Yes. So, the best candidates for low-dose radiation are patients with mild to moderate pain, around, you know, 4 to 6 on a pain scale, who have not experienced adequate relief from conservative treatments such as physical therapy, exercise, weight loss, topical medications or cream. We typically prefer to treat patients who are over 50, as this helps balance the treatment benefits with the very small long-term risks associated with radiation exposure.

Host: Okay. Let's kind of go through the treatment journey, if you will, Doctor. Like, how many appointments should people expect? How quickly will they see results? And, you know, sort of measuring or tempering their expectations, like what improvements should they anticipate going into this?

Dr. Sandeep Bhave: So, there are a variety of steps that take place. If a patient is interested in low-dose radiation, they can speak with their primary care provider for a referral, or they can contact our office directly. We accept self-referrals. I then will see you for consultation, either me or one of my colleagues will. And we'll examine you, confirm the diagnosis of osteoarthritis or other musculoskeletal condition, and assess the severity.

We'll determine whether low-dose radiation is an appropriate treatment option for you. After a detailed discussion and you decide to proceed, we would then plan the next steps, which include a CT simulation. This is a specialized CT planning scan, which helps create custom immobilization devices such as a vacuum mold to make sure that the patient is positioned the same way for each treatment. This allows us to deliver the radiation accurately and consistently.

Then, about a week after that planning scan, treatment begins. Low-dose radiation is delivered in six treatments every other weekday, so two weeks, three treatments a week. Each visit lasts about fifteen minutes, but the time that the radiation is on is only a minute or two. I joke with my patients, when the radiation beam is on, you can't see it, feel it. You're not radioactive, not turning into Batman, Spider-Man, nothing like that.

Host: Yeah.

Dr. Sandeep Bhave: Most of the appointment is spent carefully positioning you to make sure the treatment is delivered precisely. That's why it's fifteen minutes. And during the course, I will also check in with you to make sure you're doing well. Although side effects during treatment are extremely uncommon.

Now, with regards to when do you expect improvements, because patients ask me, "When am I going to start to see improvements?" And I temper expectations. The effect is delayed. Unlike a steroid injection, which provides relief within days, low-dose radiation works gradually to decrease inflammation. Most people do not notice improvement immediately. It often takes about two months or longer to experience meaningful symptom relief.

That's why I set up a follow-up visit about three months after to see whether it's helped. But when the effect starts to come in, it should be pretty dramatic. About 70% of people experience benefit. And if we fall into that 30% that doesn't, we talk about perhaps giving a second course. And because about half of those patients who don't respond initially may have a benefit.

So overall, the response rate could be about 80-85%. And when the benefit starts, it can be long-lasting, with many patients experiencing relief for years. And if we get unlucky and it comes back later on, we can talk about repeat treatment. And further, the radiation therapy is given at such a low dose that it doesn't preclude us from doing any surgery. If the patient decides to get a joint replacement or arthroscopic knee surgery or steroid injection or anything else like that, it doesn't preclude because it doesn't affect wound healing or any surgical issue at all.

Host: That's great.

Dr. Sandeep Bhave: Side effects from this are extremely rare, and most people notice no side effects. The main risk is a theoretical risk of causing a radiation-induced cancer. But there have been no reported cases of radiation-induced cancer for this dose. Nevertheless, when I counsel patients, I'm conservative, and I estimate that this risk is approximately one in ten thousand, which is very low and must be weighed against the many benefits of treatment, including improved quality of life.

Host: Yeah, absolutely. The million-dollar question for you, Doctor, is the procedure covered by insurance?

Dr. Sandeep Bhave: This is a great question, and patients ask me this all the

Host: I'm sure.

Dr. Sandeep Bhave: I'm always upfront with them that this treatment is typically covered by both Medicare and commercial insurance plans. But we're always diligent before treatment to check with their specific insurance company and plan to confirm coverage as well as discuss any out-of-pocket costs that the patient might be responsible for. Because our goal is always to make sure that the patient has a clear understanding of their benefits before proceeding.

Scott Webb: Right. That's good stuff today. As I told you, like I definitely know about osteoarthritis and I knew about radiation, but not this low-dose variety, the stuff that you're doing for, you know, folks with osteoarthritis or plantar fasciitis and so forth. Just finish up today, doctor. Final thoughts, takeaways when we think about this really cool option for folks. What do you want them most to know about this?

Dr. Sandeep Bhave: Well, I want them to know that low-dose radiation is safe, effective, non-invasive, form of treatment that can provide durable relief for patients with, osteoarthritis or other musculoskeletal conditions. It has minimal side effects and a high likelihood of improvement, and it's an attractive alternative for people who may have not found benefits with conservative treatments and may want to delay the need for more invasive procedures like surgery.

Host: Right. Right, exactly. Like, for those of us who maybe who've tried the conservative stuff and we're not quite ready for, you know, total knee replacement or hip or whatever it might be, this is somewhere in the middle there, kind of the sweet spot, right?

Dr. Sandeep Bhave: Yes.

Host: Yeah, that's perfect. Well, listen, I appreciate your time and your expertise. Thanks so much.

Dr. Sandeep Bhave: Okay. Thank you.

Host: And to learn more, visit franciscanhealth.org and search radiation therapy for osteoarthritis. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.