ell,

I noticed the same little growth in the cord following RT. It seems to have stopped, but only time will tell. Also, I had two nodules/dermal pits that were close to the active nodule. These dermal pits have been dormant for about 15 years. They showed signs of activity (swelling) following RT. They seem to have stabilized, but again I'll wait to see.

ell:

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Contrary to what I've read on this forum, Crimaldi says RT can shrink and stop progression of cords because they are the same substance as the nodules. Any opinions of that?

Also, I'm curious as to if anyone has had xiaflex when there was a cord but before there was contracture? I feel like the fact that my fingers don't bend all the way back is indication that contracture is in my future. I'd do the radiation again in a heartbeat, in spite of the 2 hr drive each way, and am hoping a more invasive procedure can be delayed. However, I don't plan to wait until I have a full contraction to try other things.

Thanks for reading & best of luck to all.

Upfront comment: We don't know what causes Dupuytren's and how it looks like in its very initial stage. When you have a palpable nodule it obviously has developed already for a while. Because we don't know much about the disease development we are not sure either how radiotherapy works. It's all a little speculative. Also the RT treatment regimes are empirical. Research means trying out and seeing what helps.

The 8-12 weeks are empirical and seem to help the skin to recover. If you do less than 30 Gy you can try to do it in one go an that's why the 21 Gy are typically appplied within 1.5 weeks. And it works. Not totally as well but nearly as well as 30 Gy. But 15 Gy might not be enough or rather, the optimum dose will depend on the size and status of the treated nodule. For some people 15 Gy might already suffice.

Cords in their core are made of similar or the same material as nodules, so Dr. Crimaldi is right, RT can shrink and stop progression of cords. But it is not very likely. If you look at the figure in the section "Radiotherapy - when to apply best" on http://www.dupuytren-online.info/radiation_therapy.html then you see that on an average the odds become worse after the first year after detection of nodules. If you waited 4 years RT might already be useless although occasionally it might still be effective. At that time nodules typically have started to grow into cords. If Dupuytren's is very aggressive, RT might still help. A forum member, newman, had RT after 15 or so surgeries and it helped him stabilize his situation. Empirically the best advice is, if you want to have RT do not wait too long. If it works on cords you were lucky and there is nothing wrong with being lucky, right?

Xiaflex ought to be injected in way that it is contained within the cord. If it leaks out of the cord it might damage joints and tendons. Having some contracture will make it easier to break the cord after injection. Xiaflex is considered an alternative to surgery and that's how it is marketed; it is targeted to become the new gold standard. Surgery, because of its side effects, is usually not recommended before you have 20 deg contracture and I would think that's why they used the 20 deg threshold also in the initial Xiaflex trials.

Wolfgang

moondanc:

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I think it's fascinating that Crimaldi says RT can shrink and stop progression of cords. ... With regard to Xiaflex ... It was pointed out to me that without contracture (duh) it would be very, very difficult to "break" the cords. I suppose with enough Xiaflex you could "dissolve" the cords but I'd certainly be afraid of what else would dissolve. I do know that during the trials they did have cords spontaneously break before the appointment the following day to officially break them. I suppose it depends on the size of the cords. I guess now they're waiting more than 24 hrs to manipulate the hand after Xiaflex injection-- more time for the nasty substance to be in your body!

Diane

Edited 08/30/13 08:47