Is there anything that shows how much area around nodules should be included in the field for treatment with radiation therapy?

I was to begin RT today, but as they were setting me up I asked what area they were planning to irradiate and was told it would be the entire area in the circle on my palm. Well, this does cover all of the nodules, but it also covers a great amount of my hand that does not currently have any sign of DD. When I met with the doctor for the CT scan, I understood that they were making a die that would include only the nodules and a limited area around the nodules.

There is a lot of my hand included in the circled field that does not have nodules and that concerned me enough to halt the therapy until I had a chance to speak to my doctor (he was on vacation, but had given instructions to another doctor.) My doctor was kind enough to call me and we ironed out why the misunderstanding, but he feels the entire area should be irradiated. I fear it is more area than is needed and if any nodules appear in those currently non-diseased areas, it could preclude the option of radiation therapy to treat them.

I live in Alaska and have found no doctors on any list for treating Dupuytren's with RT. I called around the learned that this doctor has treated 3 patients. I wish he had more experience, but the only way he can get that experience is by having patients with the disease. He did speak with a doctor in San Diego and did some research on the treatments being performed in Germany.

If more detailed information is available, I would much appreciate it if you can direct me to it! I am to meet with my doctor on Wednesday.

Thank you!

There needs to be some margins for areas of disease that cannot be seen or detected through palpation. Since RT is done when there are recent active signs of proliferation, and not just one or two nodules, this invariably means taking in the whole palm. Then there is the question of whether there is disease present, undetected in the fingers below the PIP joint, so that usually gets covered as well. The masks I had covered most of the palm short of the wrist, and one third of the fingers, thumb excluded.

My identified nodules and the treatment area can be seen here:



It went quite a bit outside of the palpable nodule area. I understood it as prevention.

And here is the markup from the examination 3 months later, before the 2nd RT series. The crosses mark the nodules which could no longer be felt:



Today, one year after the first treatment, all nodules except for the one in the already much more advanced and contracted pinky have disappeared or all but disappeared from what I can feel through self-examination (will try to have confirmed by one of my doctors).

Stef

[54 year-old male, DD diagnosis 2006, RH contracture and NA/PNF 2014, RT 2015, wearing night splint glove]

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	Palpation 3 months after 1st RT series SZHH.jpg (26x) Mime-Type: image/jpeg, 529 kB
	hands marked 10-2015.jpg (21x) Mime-Type: image/jpeg, 68 kB