Wolfgang,

Your answer to "related" is very interesting...Actually Dr. Tripuraneni in LaJolla, CA says exactly the same thing as Dr. Kline...I wish these Drs. would post any data they have available re: "radiation after NA to stop progression".

I myself am confused about what to do...I had NA two weeks ago with Dr. Eaton on small pinkie PIP and Dr. T. suggested RT immediately following the NA...I have postponed my appt. I had with Dr. T. for two reasons. First... I am involved with phys.therapy for the finger to try to get more flexibility on the still very stiff joint (which I feel is more important)...and second...the cord, nodule and dimple I had on the palm of the hand are completely gone after NA, my palm is totally flat and, like you, I think what if I needed it in the future?

I think I will schedule instead another consultation appt. with Dr. T. to discuss these issues..

Hi All,

Dr Kline here. I am a big proponent for radiating dupuytrens and have been doing so for the past four years. I have a radiation oncologist here in Boise who has had experience with e-beam radiation and dupuytrens disease during her residency and handles my local cases. Over the years, I have built up an extensive network of radiation oncologists throughout the western USA because a large portion of my patients live outside of Idaho and want to have this done in their hometown.

I have found the radiation oncologists informed and receptive to performing radiation for dupuytrens disease, they all seem to know about it! Initially, I was recommending this only on early active disease (node based), but as I developed more experience with NA, I found that the female patients were having a faster rate of recurrence then males. My local radiation oncologist and I decided to start radiating dupuytrens after NA release in women only if they had stage II or less, and had a perfect release status post NA (flat palm and good extension in all fingers). We do not have 5 year data on this yet but so far, so good - only one failure so far (recurrence). Over the last 2 years we've started adding men to the protocol. We try to radiate the hand within 72 hours after release (NA), and follow the standard German protocol. Plans are to get a paper out on this in 2 years after more data and patient follow up. The goal here is to stop progression of the disease, or at least slow it down.

As a side note, I have had my own hands treated exactly this way, with an early release of both little fingers followed by radiation. I found the side effects very tolerable, one day of redness and some dryness of the palm. It has been 2 years post-radiation for me with no progression of my dupuytrens. If your age is greater than 40 the risk of cancer is virtually zero.

Here are the results of a recent long term evaluation of radiation therapy, indicating 70% of patients experience no progression of disease after radiation and also supporting the fact that cancer risk from this is virtually nil.



Strahlenther Onkol. 2010 Feb;186(2):82-90. Epub 2010 Jan 28.
Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years.
Betz N, Ott OJ, Adamietz B, Sauer R, Fietkau R, Keilholz L.
Department of Radiation Oncology, University Hospital Erlangen, Universitätsstrasse 27, Erlangen, Germany.
BACKGROUND AND PURPOSE: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. PATIENTS AND METHODS: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term

Thank you Dr. Kline for your long and informative post.

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My local radiation oncologist and I decided to start radiating dupuytrens after NA release in women only if they had stage II or less, and had a perfect release status post NA (flat palm and good extension in all fingers). We try to radiate the hand within 72 hours after release (NA), and follow the standard German protocol.
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My NA was successful (flat palm, small finger PIP went from 90 degrees to about 15 degrees, and DIP boutonierre deformity was corrected but DIP joint is completely stiff, both joints were frozen for many yrs.)...

My thought is ... I need to work out the stiffness before I do RT, for it to be more effective on straight fingers... If there was a place to do RT closer to Los Angeles than LaJolla I could be doing the RT and physical therapy at the same time.

By the way, I am a believer in RT, I had my other hand and left foot radiated in Nov. in LaJolla with Dr. Tripuraneni..great results on both.

Any comments are appreciated.

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Hi All,

Dr Kline here.[ snip] Initially, I was recommending this only on early active disease (node based), but as I developed more experience with NA, I found that the female patients were having a faster rate of recurrence then males.

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I will be attending it. Heinrich Seegenschmiedt will review RT for Dupuytren's and present a summary of current results. I will forward the question to him and make him also aware of our discussion in this forum.

Wolfgang

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Wolfgang,

Another thought about this...

Wolfgang, are you attending the DD Symposium in May?... if so...if there are radiotherapy Drs. attending can the question be posed to them re: "using RT to stop progression immediately following NA"...

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