wach:

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Nodules can be palpated, no need for MRI or CT, the latter including considerable radiation exposure.

Thanks for sharing. Once you have the location of the nodules which a doctor with little DD experience can perhaps not palpate with certainty, and you have decided it is the right time to get radiotherapy, the way I see it there is no need for further CT, MRI or modeling, especially at the kind of cost you mention. Afaik there is no adjustment made for depth in the protocol. The important thing is to define the area to be treated so that you don't miss a nodule by a couple of mm and then have to start over again when it grows.

Stef

[55, Dupuytren diagnosis 2006, RH contracture and PNF/NA 2014, radiotherapy RH 2015, LH 2017 & 2018, night splint glove RH]

To be more precise, you want to have a safety margin around the detected nodules, because when new nodules appear, they are often in the vicinity. A less experienced doctor may treat just the nodules he sees. Has happened to me. Others may correct me on that, but I'd say the treated zone should extend about 2 cm around the nodule(s), but may depend on a number of other factors I am not an expert in. Best raise the question how he defines the area to be treated with your doctor.

I'm now in debate with the Korean oncologists about the protocol. One of them is willing to go as far as 10 fractions at 2gy, but might be persuaded to increase to 3gy. The other is prepared, if I insist, to follow Dr. Seegenschmiedt's protocol of two series of 5 fractions at 3gy, although he would be happier with the alternative of 7 fractions in one series. But he cannot understand the purpose of the 8-week break between the series. In fact, Seegenschmiedt came to believe that the two series of 5 x 3gy with a break of 12 weeks gives the best results.

At the moment, neither is prepared to allow a 2cm margin for subclinical disease (recommended by Dr. Seegenschmiedt as well as Stefan_K.) - they don't want to go beyond 5mm.

As someone who knew nothing about either Dupuytrens or radiotherapy until a few weeks ago it's not easyfor me to argue with these professionals and of course I respect and understand their position. It would be helpful if someone could explain to me exactly why the break (of 6-12 weeks) is required, so that I can put this to the doctors. All I have been able to suggest is that it minimizes adverse effects to the skin and allows it to recover, but this idea doesn't impress them.

ProfS addresses the protocols, dose and break, in his talk at the 2015 conference https://youtu.be/x_vecaIme58.

Most of the studies with a control have been done using the 5x3Gy break 5x3Gy, examples http://dupuytrens.org/DupPDFs/2010_Betz.pdf and http://dupuytrens.org/DupPDFs/2012_Seegenschmeidt.pdf.

There is a paper comparing doses https://www.ncbi.nlm.nih.gov/pubmed/11172962. Edited to add https://www.ncbi.nlm.nih.gov/pubmed/11233838. There are many papers on the topic and I’m not really qualified to analyse them or comment further. Except to say the person who has led the way in this field, ProfS, uses the 30Gy with break protocol.

Not sure about the margins, the counter argument would be why 5mm and not that used by Drs experienced in treating the disease?

Edited 01/31/18 19:04