Radiation Therapy for Nonmalignant Diseases: An ASTRO-ESTRO-DEGRO-RANZCR Framework

The field of radiation medicine has an opportunity to explore emerging indications, including nonmalignant disease, where radiation therapy may be beneficial. Because radiation therapy has anti-inflammatory and antiproliferative effects, there is rationale to deploy it in the management of a range of nonmalignant conditions including plantar fasciitis, Dupuytren disease, and osteoarthritis. Given the prevalence of many potentially relevant pathologies, a body of evidence (albeit commonly lower level), and an often absence of a widely accepted standard treatment for a particular patient cohort, the potential for the field of radiation medicine is immense. Although due to the low radiation doses, simple radiation therapy techniques, and low burden of acute toxicities, the barriers to managing nonmalignant conditions are relatively low; there are challenges relating to building a stronger evidence base, constructively engaging with different disciplines and consumer groups, and the possibility that without proactiveness, other craft groups with lower expertise in radiation medicine will move into these indications. Fortunately, many of the likely solutions have already been tested and validated in the management of cancer. The first pillar is the generation of high-quality evidence, the second is education of both trainees and colleagues, and the third aspect is engagement across the spectrum from other medical specialities through to consumers. This intersociety framework presents a pathway to help responsibly and efficiently establish the place of radiation therapy in the management of nonmalignant disease.