Radiotherapy for Non-Malignant Diseases: An ASTRO-ESTRO-DEGRO-RANZCR White Paper.

The field of Radiation Medicine has an opportunity to explore emerging indications, including non-malignant disease, where radiotherapy may be beneficial. Since radiotherapy has anti-inflammatory and anti-proliferative effects, there is rationale to deploy it in the management of a range of non-malignant conditions including plantar fasciitis, Dupuytren's 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 radiotherapy techniques and low burden of acute toxicities the barriers to managing non-malignant 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 Inter-society white paper presents a pathway to help responsibly and efficiently establish the place of radiotherapy in the management of non-malignant disease.