Low-Dose Radiation Therapy for Bursitis

Low-dose radiation therapy (LDRT) is an outpatient treatment that directs a very small amount of radiation at an inflamed area, aiming to calm the inflammation that drives chronic pain. Bursitis, particularly trochanteric bursitis at the hip, is one of several benign inflammatory conditions treated with LDRT, most often studied in older adults alongside related joint conditions.

What the Evidence Shows

A prospective study of adults aged 70 and older looked at LDRT for several painful conditions, including trochanteric bursitis, heel pain, Achilles tendon pain, and knee osteoarthritis. Of the 166 patients, 27 had trochanteric bursitis. They received single doses of 0.5 to 1.0 Gy, for a total of 6.0 Gy. Across all conditions, average pain fell from 6.4 to 4.5 on a 10-point scale right after treatment, and about half of the patients with longer follow-up had a good response.^[1]

A Swiss study looked specifically at greater trochanteric pain syndrome, the term now often used for pain on the outside of the hip that used to be called trochanteric bursitis. It included 65 patients (71 hips) treated with 3.0 to 4.0 Gy per course. Two months after treatment, 59% had a good response. Patients who received two courses, who had responded to a steroid injection before, and who had no structural changes on imaging tended to do better.^[2]

Radiation for bursitis also has a long history. A review of radiotherapy for inflammatory conditions in the 1920s to 1940s, covering more than 37,000 patients across hundreds of studies, reported that conditions including bursitis often responded with relief lasting months to years.^[3] Doses and equipment then were very different from today's.

Be aware: none of these studies compared LDRT with a sham treatment, so they cannot show how much of the improvement was due to the radiation itself.

Typical Schedule

• Total dose of about 6 Gy in many published protocols, though some programs use a lower total dose closer to 3 Gy, split into 6 treatments
• Treatments given 2 to 3 times per week, over about 2 to 3 weeks
• Each visit takes roughly 10 to 15 minutes; no needle, sedation, or recovery period

Who May Be a Candidate

Programs generally consider adults with chronic bursitis, most often trochanteric bursitis at the hip, who have already tried conservative treatments such as physical therapy, activity modification, or corticosteroid injections without lasting relief. Most of the published evidence involves older adults, though programs may consider younger adults case by case. A radiation oncologist weighs age, duration of symptoms, and prior treatment history before recommending it.

References:
1. 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;98:958-963. PubMed
2. Staruch M, et al. Low-dose radiotherapy for greater trochanteric pain syndrome: a single-centre analysis. Strahlentherapie und Onkologie. 2023. PubMed
3. Calabrese EJ, et al. Radiotherapy treatment of human inflammatory diseases and conditions: Optimal dose. Hum Exp Toxicol. 2019. SAGE Journals