Melanie Cole (Host): Welcome to A HN Med Talks, an informative resource for
physicians across various specialties as we delve into the latest medical
insights and best practices, ensuring you stay at the forefront of your field.
I'm Melanie.
Today we're highlighting osteoarthritis treatments in radiation-oncology.
Joining me is Dr.
Shara Shah.
He's a radiation-oncologist And the division chair of radiation-oncology
at a HN Cancer Institute at Allegheny General Hospital.
Dr.
Shah, thank you so much for joining us today.
Before we get into this, tell us a little bit about the burden of osteoarthritis And
what has been the histotripsy treatment.
So why are we doing this exciting new modality?
Dr Chirag Shah: Yeah.
Thank you for having me Melanie.
osteoarthritis is one of the most common health afflictions face.
Americans, particularly as our population ages, it's a disease
that can not only cause discomfort, it can impact quality of life.
Traditionally, treatments have ranged from the very basic treatments
that we think about, things like physical therapy, anti-inflammatories
to more invasive procedures like injections of steroids and synthetic.
Joint fluids And then to the most invasive, which have been typically
things like joint replacements.
and all of these treatments can be effective at different
stages of osteoarthritis.
But there's been a need and a want for another non-invasive treatment
for osteoarthritis, and that's where low-dose radiation offers an opportunity.
Melanie Cole (Host): That's really cool.
So why are we seeing a resurgence in the use of radiation for benign disease?
When did this start?
Give us a little evolution of this.
Dr Chirag Shah: I think it's interesting when people ask me about this, exciting
new technique and I have to laugh a little bit and tell them that This is a technique
that dates back to the early 19 hundreds.
So shortly after the discovery of radiation And the beginning of using it
for medical treatments, it was studied for the use of benign diseases, and one of
those benign diseases was osteoarthritis.
So some of the first reports come out in the 1930s and 1940s showing the benefits
of low-dose radiation for arthritis.
It fell away at treatment in the 1970s and 1980s in the United States, but remained
a common treatment choice in Europe.
One-third of all radiation treatments in Germany, for example, are f benign.
I think what we've seen over the past five years or so as a resurgence in
the United States as people have become interested and programs and guidelines
have been developed, such that it was even an article in the Washington
Post recently discussing the use of low-dose radiation for osteoarthritis.
Melanie Cole (Host): Wow, that's pretty cool.
and it has been around.
Quite a long time.
So tell us a little bit about the process itself And the data that
surrounds this low-dose RT for arthritis.
what are we seeing as far as outcomes, patient satisfaction,
ease of application, all of that.
Dr Chirag Shah: Yeah, so I think it's important to talk through
kind of the data And then kind of what it means for patient's.
So we have robust data on the use of low-dose radiation therapy for
arthritis, and I think the first thing that patient's ask me is
what does low-dose radiation mean?
And I'm primarily a breast cancer oncologist, And so I
use that as a good comparison.
The total dose we use for low-dose radiation is about 10% of the dose we
use for breast cancer treatment, so at a much lower dose per treatment.
And studies have consistently shown anywhere from a 50 up to a 70 or
80% benefit with the use of low-dose RA radiation for osteoarthritis.
And that can include things like pain, functional outcomes, um, quality of life.
There was even a recent randomized trial looking at low-dose radiation therapy
for arthritis of the knees that showed a positive benefit with the use of
low-dose radiation, for osteoarthritis.
In terms of what this means for patient's, we typically see patient's
for consultation first, making sure that they're good candidates for radiation.
we don't treat patient's who had previously had knee replacements or
joint replacements of the affected area.
we make sure that they don't have a history of conditions that would
exacerbate side effects of radiation.
And we make sure that their pain and discomfort isn't caused by an alternative.
Ideology.
For example, I saw a patient who had a tear in their meniscus and it was unlikely
low-dose radiation was gonna impact that.
And so we talk about discriminating, what we can help with And what we can't.
If they decide to proceed with treatment, we do a CAT scan to plan the radiation
to create a three-dimensional model of the joint, And then they subsequently
undergo treatment two to three times a week for just six total treatments.
Each treatment takes about 10 to 15 minutes.
They lay on the table, the affected joint is treated, and they're on their way.
in terms of side effects, in a series of about a thousand patient's, one
patient had mild redness of the skin.
Long-term, these doses are very low, so we don't expect any
issues with long-term healing.
We don't expect any issues if the patient needs a joint replacement down the road,
as the doses are very low and they're able to do all their normal activities during
the course of low-dose radiation as well.
Melanie Cole (Host): Well, my next question was gonna be about counseling
patient's on the benefits versus the risks, and you just basically said
the risks that's great for patient's.
What are they saying about this?
Dr Chirag Shah: Yeah, you know, we've had really great outcomes.
So we started the program at a HN in early 2025.
We've treated several hundred patient's so far, and we've heard really great stories.
We've heard from patient's who were previously really
struggling to use their joint.
Who come in telling us that they feel so much better and are doing great.
And we have patient's telling us that This is gonna allow them to avoid having
a surgery or needing continued injections.
So that's been great.
I do always counsel patient's that some patient's unfortunately
don't get that benefit And that while many do, some don't.
I always also, in terms of long-term risk counsel patient's, that any
x-ray, whether that be a chest x-ray, a CT scan or low-dose radiation for
arthritis can in theory cause a cancer.
But we feel that risk to be very, very low given the dosages
of radiation we're using.
Melanie Cole (Host): Yeah, low-dose radiation really has so many benefits
and we're learning so much more.
What other diseases or conditions do you see emerging or growing areas
for low-dose radiation therapy?
It's a pretty exciting time in your field.
Dr Chirag Shah: Yeah, I think it's one of those back to the future times in
the specialty of radiation-oncology And that we had kind of abandoned
some of these ideas of benign disease.
actually my group recently just published a paper in the Lancet Medical
Journal using low-dose radiation for hydradenitis, which is a chronic skin
condition that's very hard to treat.
we also use, have considered using radiation for things like plantar
fasciitis, another inflammatory condition, as well as things like
keloids and, other benign conditions.
So we continue to see growth of the use of benign, indications
for radiation, and I expect that to continue in the years to come.
Melanie Cole (Host): Dr.
Shah, tell us a little bit about the a HN Department of Radiation-Oncology, the
approach to radiation for benign disease.
Tell us about your team And the multidisciplinary approach
to all of these conditions.
Dr Chirag Shah: the radiation-oncology department in the Allegheny
Health Network Cancer Institute is actually 12 separate centers in
our network currently, And we have.
22 radiation oncologists as well as many radiation physicists,
therapists, nurses, dosimetrist.
So we're a big group.
and really as part of benign disease, I joined the Cancer
Institute a year ago as the chairman.
and my approach to benign disease is to be consistent.
So regardless of what center your patient's are seen at in the
Allegheny Health Network, they're gonna get consistent treatment.
And what that means for benign disease, for example, is we have
a department-wide guideline.
So that helps with things like.
The age that we treat patient's at the indications, the workup, all
of that, but also how we treat the patient's in terms of the radiation.
So making sure the fields are standardized, the doses
we're using are standardized.
The regimens are standardized that way.
My biggest goal has been it shouldn't matter what center in
the enterprise you're treated at, you'll be treated the same.
And that's really been effective also.
Every one of these cases is peer reviewed, meaning another physician or another
group of physician reviews the case on top of the primary doctor to make
sure we're following that ethos of high quality, high consistency, radiation care.
We're similarly using, those approaches when we expand into other benign
indications, making sure that we're doing it in a thoughtful evidence-based
way that allows consistent high quality care to be delivered.
Melanie Cole (Host): That's so important, and Dr.
Shah finally tell us a little bit about.
Life after radiation therapy for osteoarthritis, as we know that
it is degenerative and chronic and age related as we get on in
years, where do you see this going?
What do you see happening for these patient's?
Do they come back in a few years later?
Do they still continue?
There are NSAIDs or There are other medications for that joint.
What happens after?
Dr Chirag Shah: You know, in terms of what happens after the radiation, it really
depends on how the patient's respond.
patient's who have a complete response after that first course
of radiation, I typically tell them to stay in touch and if they need
anything to call me anytime, I offer.
Will hear.
And I remember a very, interesting story.
I had a patient who had knee osteoarthritis and I treated them and
they told me they got so excited about playing pickleball, they overdid it.
And so about six months to a year later they were like, we had some
pain come back and I retreated them and, And that made them feel better.
and if they do get symptoms, we can retreat them in that situation.
also if it eventually progresses, they may end up needing to see
orthopedic surgery for a replacement.
For the patient's I see in follow-up who have had a partial response
will often offer them a second course of radiation therapy even.
Three months after their first course to see if we can get
them to a complete response.
And the goal is if they're feeling better to get off their NSAIDs if they
don't need them to be increasingly active and use, being functional.
So that's how we approach it.
we do have the opportunity to retreat, And we are a part of their multidisciplinary
team throughout their care journey.
Melanie Cole (Host): This is great information.
Dr.
Shah, do you have any final thoughts for other providers that are counseling
their patient's about possible radiation therapy for osteoarthritis And you, what
you'd like them to know about what you're doing there at the A HN Cancer Institute?
Dr Chirag Shah: I think just like most, diseases in healthcare, osteoarthritis
is a multidisciplinary, team.
And so I spent a large part of my initial journey in this program
meeting with primary care physicians, orthopedic surgeons, sports medicine
physicians, and if you ever have a patient that has a question, never
hesitate to reach out to me or my team.
We're happy to look at x-rays, discuss through the treatments,
discuss alternatives, and to see patient's whenever needed.
So really it is a team sport and we're always here to engage with our
colleagues on this topic or any other.
Melanie Cole (Host): Great information, Dr.
Shah.
So well put.
Thank you so much for sharing your expertise with us today.
And to learn more or to refer your patient to Dr.
Shah, please call 8 4 4 md refer, Or you can visit find care.ahn.org.
Thank you so much for listening to this edition of A HN Med Talks
with the Allegheny Health Network.
I'm Melanie Cole.