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another newbie to the site
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04/04/2010 16:31
LubaM. 
04/04/2010 16:31
LubaM. 
Re: another newbie to the site



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..

04/04/2010 16:43
LubaM. 
04/04/2010 16:43
LubaM. 
Re: another newbie to the site

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"...

04/04/2010 17:14
Dr. David Kline

not registered

04/04/2010 17:14
Dr. David Kline

not registered

Re: another newbie to the site

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

04/04/2010 17:24
DR. David Kline

not registered

04/04/2010 17:24
DR. David Kline

not registered

Re: another newbie to the site

Previous post got cut so here is the full article summary.


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 outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response.

RESULTS: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy.

CONCLUSION: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a "salvage" operation is still feasible.

04/04/2010 21:38
LubaM. 
04/04/2010 21:38
LubaM. 
Re: another newbie to the site

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

Quote:
___________________________________________________________

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.
____________________________________________________________

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.

04/04/2010 23:39
related 
04/04/2010 23:39
related 
Re: another newbie to the site

Dr. Kline,
Thanks for weighing in on this. After Wolfgang's message it gave me reason to pause and think about radiation. I have a concern about the accumulated amount of radiation on my body because as a teenager I had radiation therapy for acne over my face, back and chest in the 1950's. I don't think that is a recommended therapy anymore. My uncle (mother's side) and my sister both had melanoma. My uncle died of that, my sister is seen every 6 months and has had several cancerous growths removed. So far I have not had any cancerous growths. I was checked with a complete body scan one year ago. Would this treatment in your opinion still be safe for me given this history?

I appreciate your posting this detailed response. I think reassurance is absolutely necessary in order to make a more informed decision. I'm also glad Wolfgang questioned the therapy and gave his reasons, for it has brought up this very informative and healthy discussion. I say the more information the better.
-Related

04/04/2010 23:46
moondanc 
04/04/2010 23:46
moondanc 
Re: another newbie to the site

Quote:



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.


That doesn't seem fair; we're supposed to get it less frequently but I think that's changing and when we do get DD there's a faster rate of reocurrence--sure is what's happening to me. Thanks for your post and info.
Moondanc

04/04/2010 23:47
related 
04/04/2010 23:47
related 
Re: another newbie to the site

Luba -

I appreciate your voicing your concern and stating the fact that you felt confused about making choices with little information available as to the safety or effectiveness of radiation therapy to stop the progression of Dupuytrens's Disease. I find the information Dr. Kline posted very helpful towards making me feel more comfortable. Let us know what Dr T says after you consult with him. Thanks for adding to this conversation!

-Related

04/05/2010 04:22
wach 

Administrator

04/05/2010 04:22
wach 

Administrator

Re: another newbie to the site

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

Quote:



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"...


04/05/2010 04:29
LubaM. 
04/05/2010 04:29
LubaM. 
Re: another newbie to the site

Thank you Wolfgang... I will look forward to hearing what Dr. Seegenschmiedt has to say about this issue...

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