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Protocol for radiation on DD
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08/27/2013 14:49
Jolene 
08/27/2013 14:49
Jolene 
Protocol for radiation on DD

Hello,
Who knows the protocol for radiation used on dupuytren disease? Is it 6 week break or 8 week break?

08/27/2013 14:51
wach 

Administrator

08/27/2013 14:51
wach 

Administrator

Re: Protocol for radiation on DD

I don't think that matters much. It just should be a longer break to give the skin time to recover.

Jolene:
Hello,
Who knows the protocol for radiation used on dupuytren disease? Is it 6 week break or 8 week break?

08/27/2013 15:48
spanishbuddha 

Administrator

08/27/2013 15:48
spanishbuddha 

Administrator

Re: Protocol for radiation on DD

I asked ProfS this very question just yesterday. He said 12 weeks is optimum, 6-8 weeks too short. I did not ask about longer than 12.

08/27/2013 18:54
moondanc 
08/27/2013 18:54
moondanc 
Re: Protocol for radiation on DD

Any comments-- other than asking Prof S--. about the possibility of the second treatment being four years later? (I decided not to have the second round after the first round in 2009)

Diane

08/28/2013 02:43
Lowell 
08/28/2013 02:43
Lowell 
Protocol for radiation on DD

Hi: I am about to get R/T treatment (electron beam machine) in about a couple of weeks,.......I found a Dr Wolfson at the University of Miami who had attented Dr Seegenschmiedt lecture here in 2010 and has a hieghten interest in the disease as a result. But, I am going to be his first real patient for him (and he likes that, as it appears--having a real live patient finally to work on).

Should I be scared because of lack of experience, though he seems quite good in general, or should I be real happy he is going to take a real interest in making sure everything goes alright because I am the first, as it were.

He spent a lot of time with me, and went over Dr. Seegenschiedt protocols that he said he will be following: (but isn't his protocols from many years ago (or are there recent ones?)....Dont know.

My Doctor also wants to do an MRI of my hands and a CT scan to map the plan for treatment of my hands (seems kind of thourgh I guess)...... wants to make sure also there is no finger involvement----he said that would be tricker to do with radiation, as opposed to just dealing with the palms.

Anybody have any thoughts about all this?


I am apparently going to get 3grays per treatment for 5 days, then wait I guess 8 weeks, and then another 5 days......TOTAL of 30grays. Is this a good approach, anybody know?

He is also downplaying any side effects to be minimal, if any. He also said that according to previous treatments from others in other places (I guess, namely Germany), that there is about an 80% chance that I will see good results from the treatment. Does this sound right?

Anyway, open for any kind of input that anyone can give me about all this.

thanks

08/28/2013 11:06
Jolene 
08/28/2013 11:06
Jolene 
Re: Protocol for radiation on DD

Hello,
I think you are in excellent hands with Dr. Wolfson. I have spoken with him on the phone. I have met someone who has had radiation for ledderhose with him. Yes he is new in treating DD & LD. I think its awesome that he is so thorough. I am wanting MRI on my hands to make sure they get ALL the diseased area. Rest safe, put your mind at ease.

I ended up going to Dr. Lawrence Hochman in New Port Richie Florida for radiation on the foot. I choose him for a few reasons.
1. The office ran my insurance and it paid all but my deductible
2. Since I live in the Altanta Ga. area I had to fly to Florida. I have family closer to that area than to Miami.
I am 6 weeks out from 1st round of RT for foot. So far ALL is good.

Now I have early signs of DD. I go to hand specialist today. I plan to request MRI. Currently the DD is not visible to the untrained eye.
When I fly back to new Port Richie for 2nd round on the foot I will have consulation with Dr. Hochman to get the hands treated as well.
good Luck . let me know how it turns out

08/28/2013 16:00
JohnG 
08/28/2013 16:00
JohnG 
Re: Protocol for radiation on DD

Lowell:
I am going to be his first real patient for him (and he likes that, as it appears--having a real live patient finally to work on).

Should I be scared because of lack of experience

Presumably your doctor is already experienced with using the same treatment for cancer patients. In that case, I think that being a doctor's first patient for RT for DD is just fine. It's not like being the first patient for surgery.

The only issues for the doctor are

    when to treat
    what dosage to use
    what field (part of your hand) to expose.

It's hard to mess this up very much. The doctor could make a poor choice and nothing bad would happen.

The dosage is easy, because he'll just copy the German protocol, which he will find to be reasonable because it's not much different from what he uses with cancer patients.

You might need to help the doctor some with the first and third bullets above because they are specific to DD. For the "when" part, learn from reading this forum the indications of whether your disease is "active." Another issue is whether you already have significant contractions. For the Field, view pictures of fields that the German doctors have treated, and possibly show these to a hand surgeon and ask the hand surgeon to use an ink pen to mark a suggested border for the field and take a photo of this right away to show your radiation oncology doctor (this is what I did).

08/28/2013 16:00
spanishbuddha 

Administrator

08/28/2013 16:00
spanishbuddha 

Administrator

Re: Protocol for radiation on DD

Just a reminder, for RT to be effective there needs to be signs that the disease is active, the proliferation phase or just before. So symptoms such as recent changes, progression, pain, tingling, and so on. No point treating dormant modules or cords. ProfS, as discussed elsewhere (scoring thread), does not treat every case presented.

08/28/2013 18:50
Jolene 
08/28/2013 18:50
Jolene 
Re: Protocol for radiation on DD

So how do I find out for sure if I am at the stage for treating? I just return from Dr. Kay Kirkpatrick. She confirmed I am in the very early stages. She stated radiation does nothing for DD. She said the USA is not keen on radiation like the other countries. When I told her I had the crawling burning sensation she stated no research for DD states that to be a condition. She then x-ray my thumb to rule out carpel tunnel or arthritis. She treats with NA. I also asked for MRI. She said it would not show anything. I explained to her that I have LD and have been treated with RT for that. It has been a success and I have 2 weeks left before I get the 2nd round of RT. I also experience the same crawling burning sensation on the LD. In the end she did right a prescription for me to give to my oncologist in Florida stating that I am in the early stages. I asked if she knew and oncologist in Ga who would do radiation and she said no.

So my question to everyone is:

1. How am I to determine if I am at the stage for RT? Apparently I am going to have to convince the oncologist. I do experience the crawling sensation. My guess is it is active.

2. Do I listen to Dr. Kay Kirkpatrick and not attempt radiation since she says it does not work for DD?

3. Who out there has had radiation for DD?

4. How successful has iradiation been?

5. How do you make sure ALL the diseased area is radiated?

Edited 08/28/13 22:08

08/28/2013 22:20
moondanc 
08/28/2013 22:20
moondanc 
Re: Protocol for radiation on DD

In the youtube video link below-

Marco Rizzo, M.D. of the Department of Orthopedic Surgery at Mayo Clinic, discusses dupuytren's contracture and new options for the treatment of this disease. He describes multiple surgical treatment options of dupuytren's, reviewing each procedure as well as risks and impact of each option.

http://www.youtube.com/watch?v=_XwztuSx_HQ

Dr. Rizzo uses ultrasound--and he's one of the few docs I've ever heard of that does--to help with NA and "locate" the small nerves in the hand while he's doing NA. Others on this forum have said this is impossible because the nerves are too small.

I'm curious if ultrasound would be of any help locating nodules prior to radiation. I've had several docs--a hand surgeon AND my radiation oncologist say tell me MRI would not be of help locating DD nodules prior to RT. Any competent radiologist should be able to handle the Dr. S protocol and also to determine how deep to go, etc. If you can find a radiation oncologist or a radiologist that has experience using RT to treat scars or scar tissue--all the better.

I chose to have most of my hand radiated but apparently other radiologists/Dr. S only treat visible nodules so as to reserve the option of treating individual nodules in the future and more than 30gys although not to any one location. I believe I read Dr. S will go up to 45 gys--on the same hand just not all on the same nodule. I sure would like more info about this.

Diane

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