Publications about radiation therapy (radiotherapy)
The articles below are using scientific language, but their content makes them worth reading.
Ch. Eaton et al. (Eds.) "Dupuytren's Disease and Related Hyperproliferative Disorders" (Springer, Heidelberg & New York, 2012), specifically chapter 44 (p 349 ff) "Long-term outcome of Radiotherapy for Early Stage Dupuytren's Disease: A Phase III Clinical Study" by H. Seegenschmiedt et al. link_ebook and chapter 50 on radiotherapy of Ledderhose (see below).
N. Betz et al. "Radiotherapy in Early Stage Dupuytren's Contracture - Long Term results after 13 Years" Strahlenther Onkol 186 (2010) p 82-90 retrospectively analyzes the results of treating more than 200 hands with a follow-up range of 2-25 years. The results show that radiotherapy is most efficient in the initial stages of Dupuytren's disease and increasingly less effective with increasing contracture. "In case of disease progression after radiotherapy, a 'salvage' operation is still feasible." Abstract.
The book M. Seegenschmiedt, H-B Makoski, K-R Trott, and L. Brady (Eds.) "Radiotherapy for Non-Malignant Disorders" Springer (Berlin, New York, 2008) addresses a medical audience. It provides general background information, e.g. on radiobiological principles, therapeutical devices, or side effects and long-term risks, together with detailed and comprehensive chapters on radio treatment of a large variety of diseases. Specifically of interest is chapter 9 on "Morbus Dupuytren / Morbus Ledderhose" (p 161 - 192), also published online. The chapter, authored by Heinrich Seegenschmiedt, addresses etiology, pathogenesis, diagnostic aspects (including imaging techniques), and treatment strategies. The section on "Radiotherapeutic Management" covers cell level radiation effects on proliferating Dupuytren nodules, specific aspects of radiating MD/ML, risk analysis, and the current statistical results of radiating Dupuytren and Ledderhose.
In early stages of Dupuytren's contracture, radiotherapy was applied to prevent disease progression. Long-term (10 years) results and late toxicity of this treatment were evaluated in a retrospective analysis of 176 hands (99 patients). Long term results are very good if radiation therapy is applied in the early stages of Dupuytren's. - Boris Adamietz, Ludwig Keilholz, Jörg Grünert, and Rolf Sauer, Strahlentherapie und Onkologie 177, Number 11 (2001), p 604 - 610. Link: dupuytren_article (on the link scroll down for the English text).
Aiming to reduce the radiation dose, two different radiotherapies were compared (one standard, one with about 30 percent lower dose) on a total of 129 patients. After one year, results did not exhibit significant differences between both therapies, thus probably allowing lower dose therapy. Longer term analysis is under way. - Seegenschmiedt MH, Olschewski T, Guntrum F, “Radiotherapy optimization in early-stage Dupuytren's contracture: first results of a randomized clinical study”, Int J Radiat Oncol Biol Phys. 49/3 (2001) p 785-798. Link: radiotherapy The full text, explaining therapy details, is available on request as pdf from Dupuytren Society (with permission of the author).
Presentation at the Annual Meeting of the American Society for Surgery on Hand (ASSH) 2006:
The International Dupuytren Society gratefully acknowledges the authors for providing their papers for Internet publication on our web site.
The British National Institute for Health and Clinical Excellence (NICE) has approved radiotherapy for treatment of early Dupuytren's disease guidance_details . See also article in the Daily Mail online.
A study from the US concludes that radiation is a highly effective alternative in situations where surgery would result in major functional or cosmetic defects (this study does not mention the benefit of radiotherapy in the early stages of Dupuytren's). - Spear MA, Jennings LC, Mankin HJ, Spiro IJ, Springfield DS, Gebhardt MC, Rosenberg AE, Efird JT, Suit HD, “Individualizing management of aggressive fibromatoses”, Int J Radiat Oncol Biol Phys. 40/3 (1998) p 637-645. Link: us_radiotherapy.
MH Seegenschmiedt, M Wielpütz, E Hanslian, and F Fehlauer "Long-term Outcome of Radiotherapy for Primary and Recurrent Ledderhose Disease" in Ch. Eaton et al. (Eds.) "Dupuytren's Disease and Related Hyperproliferative Disorders" (Springer, Heidelberg & New York, 2012) p 409-428. First time ever reported long-term results (average of 5.5 years of follow-up) link. Also available as ebook.
25 patients with Ledderhose's disease were treated with radiotherapy and followed up for 1 - 5 years afterwards. About 80 percent of the patients reported improvements, while the rest reported stable conditions. None of the patients had to undergo surgery. - Michael Heinrich Seegenschmiedt and Mared Attassi "Radiation therapy for Morbus Ledderhose - indication and clinical results" Strahlentherapie und Onkologie 179, Number 12 (2003), p 847 - 853. Link: ledderhose_article (on the link scroll down for the English text)
R. Heyd et al. "Radiation Therapy for Early Stages of Morbus Ledderhose" Strahlentherapie und Onkologie 186 (2010) p 24-29 use x-rays and e-beam. Results: "After a median follow-up of 22.5 months, none of the patients experienced a progression of number and size of the lesions or the clinical symptoms. In eleven sites (33.3%) complete remission of cords or nodules occurred, in 18 (54.5%) a reduced number or size was noted, and four sites (12.1%) were unchanged. Pain relief was achieved in 13/19 patients (68.4%)".
Cellular Basis and General Aspects:
Paper at DEGRO '07, Hannover: M. Blaese and H. P. Rodemann "Irradiation and hyperproliferative processes : radiobiological aspects". This paper addresses the cellular aspects of irradiating Morbus Dupuytren in early developmental stages. This is a fundamental research paper addressing a medical audience. We provide the full paper because it explains why radiotherapy is effective and why it is effective specifically in the initial phase of Dupuytren's disease. Cellular basis of Morbus Dupuytren (pdf).
A summary of radiotherapy, i.e. of two pattern-of-care studies, in which about 250 institutions participated, is published in M. H. Seegenschmiedt, O. Micke, N. Willich, and the German Cooperative of Benign Diseases "Radiation Therapy of Nonmalignant Diseases in Germany", Strahlenther Onkol 11 (2004) p 718 - 730.
Page last modified: 06/24/2013