Can LDRT Treat More Than One Joint?

Yes. If arthritis hurts in more than one place, treatment can cover more than one joint. The published cohorts treat several joints per patient as a matter of course, and the 2026 American Radium Society guidance calls treating multiple joints at once "a reasonable approach"^[2][3]. Each joint still gets its own treatment plan and its own dose.

What the Published Studies Show

Two recent American retrospective studies give a picture of normal practice. One 2025 study treated 168 joints in 69 patients, about two to three joints per person, with each course delivered as 3 Gy in six fractions of 0.5 Gy over two to three weeks; 80 percent of joints showed significant pain improvement at the end of treatment^[3]. Another 2025 study treated 94 joints in 59 patients with the same 0.5 Gy times six schedule, given every other day, and reported significant pain relief in 89 percent of patients, including one patient who stayed pain-free in both knees and both hands for 14 months^[4].

How One Course Covers Several Joints

The dose is per joint, not per patient. Each joint gets the standard course, typically six fractions of 0.5 Gy for a total of 3 Gy given two or three times a week, with a separate radiation field planned for each site^[1]. The American Radium Society notes that fields and volumes depend on the joints involved, so knees, hands, and hips each get their own setup and their own plan^[2].

If a joint responds poorly, a second course to the same joint is an option about six to twelve weeks later^[2]. There is no fixed lifetime dose limit. The guidance says retreatment is decided case by case, weighing how well the joint responded, how much time has passed, and which joint is involved^[2].

How Programs Handle It in Practice

Programs describe treating several joints in the same session. One New Jersey program says hands, fingers, knees, hips, back, and shoulders can all be treated during the same session^[6]; a California practice says the same, with each session under ten minutes^[7]. Other programs stage the joints or set their own limits: Cleveland Clinic's care path covers knees, hips, hands, shoulders, ankles, and elbows, and treats no more than three sites at one time^[5].

One site the guidance singles out for caution is the spine. For most patients, the American Radium Society advises against LDRT for spine arthritis because of the larger volume of bone marrow and organs involved^[2].

How the Decision Gets Made

How many joints get treated, and whether they are done together or in stages, is worked out with the radiation oncologist. Things that go into the decision:

• Which joints are causing the most pain and limiting you the most
• Whether each joint has the kind of arthritis the treatment is meant for
• How much radiation the plan adds up to across all the sites
• Practical limits: appointment length, your schedule, and the center's own policy

Bring the full picture: every joint that hurts, what you have already tried, and how long the pain has lasted. The radiation oncologist then plans each site and decides what gets treated when.

References:
1. Dove A, et al. American Radium Society (ARS) Appropriate Use Criteria (AUC) for Low-Dose Radiotherapy for Treatment of Osteoarthritis. American Journal of Clinical Oncology. Published online May 25, 2026, ahead of print. PubMed
2. American Radium Society (ARS) Appropriate Use Criteria (AUC) for Use of Radiotherapy for Treatment of Osteoarthritis. Full guideline document. American Radium Society. 2026. Full guideline (PDF)
3. Koneru BN, et al. Low-Dose Radiation Therapy for Osteoarthritis: A Retrospective Single-Institution Analysis of 69 Patients and 168 Joints. International Journal of Radiation Oncology, Biology, Physics. 2025. Red Journal
4. Shah N, et al. Low Dose Radiation Therapy (LDRT) for Osteoarthritis: A Retrospective Study of 59 Patients and 94 Joints Treated. International Journal of Radiation Oncology, Biology, Physics. 2025. Red Journal
5. Low-Dose Radiation Therapy Reemerging for Osteoarthritis. Cleveland Clinic ConsultQD. Cleveland Clinic
6. For Osteoarthritis Patients, Radiation Can Bring Winter Weather Relief. RWJBarnabas Health via Newswise. Newswise
7. Epic Care Offers Low-Dose Radiation Therapy as an Effective Treatment for Osteoarthritis and Other Benign Conditions. Epic Care. Epic Care