Thanks Gazza,

Your advice is much appreciated. I think there is easily 2 cm margin in the drawings on my hand, I have luckily small nodules and cording. But in 4 Mo I have seen it double in size and location, so that is why I am going the RT route.

I am going in for my final 2 hour prep on Wed so will bring up the idea of a slightly larger area to radiate. Both Dr. Nelson the hand surgeon, and my RT Oncologist spent plenty of time palpitating my hands and feet...so I am feeling pretty good about the location of disease, and like you said, doing more than less.

I also have one 3cm by 2 cm lederhose fibroma on my rt foot, and it has not changed size, nor caused any discomfort whatsoever, so I am taking a wait and see attitude with that.

Of course I take to heart what Seph said: the choice has always been to "wait and see" vs. radiate while the time is right.
When you look at the minimal stage of disease in my hand, one must consider why take such a harsh approach? The answer is: because it's arguably now or never...the success rate is much higher before contracture begins, and then there is the straightening of the finger issue to deal with....why not nip it in the bud when there is evidence of an 80-85% long term success? (especially when the danger of future cancer is so low)

From what I read the odds are 1:3 that my finger will contract soon, at least that is what my, and other people's interpretation of the clinical data has shown....

But of course, one never knows....

Good point, Lanod!

And thanks for the continuing interest and support....I will try to find that info from Germany, as last thing I read was 6 week.....but it's likely I missed something more recent....

I believe you need to look at the data to understand the size of the wound healing problem.

1. Surgery after RT
N. Betz et al. "Radiotherapy in Early Stage Dupuytren's Contracture - Long Term results after 13 Years" Strahlenther Onkol 186 (2010) p 82-90 report that 39 patients had surgery after RT (so obviously that's possible!) and 2 of them (=5 %) experienced delayed wound healing problems.

2. Wound healing without prior RT
Keith Denkler "Surgical Complications Associated With Fasciectomy for Dupuytren's Disease: A 20-Year Review of the English Literature" ePlasty 10 (2010) E-location ID: e15 reports an average of wound healing complications after fasciectomy of 23 % http://www.eplasty.com/index.php?option=...&Itemid=116

Keith Denkler's data certainly include more types of wound healing problems than just delayed wound healing, so the data might be not completely comparable. Now, do we have a problem with wound healing after RT? I am not sure whether there is a problem at all and if there is one it seems to be a small one.

Wolfgang

GaryBall:

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callie:

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GaryBall,

You said, "More RT makes the healing process more difficult if surgery is later required....".

That seems to be another controversy. My Dr. said that there would be no problems with surgery following RT. That is another reason she suggested the entire palm area.

Hi Callie.

This is something that has come up many times with hand surgeons......operating on previously radiated areas can make the healing process more difficult......Thus many do not recommend RT......My understanding is that this point of view is starting to soften as 30gy of radiation is not excessive and healing if surgery is later required has not been a major problem.....

However....if we keep on radiating over the same area we increase probability that healing becomes an issue if surgery is required......hence my point regarding the best process for RT........

Proper palpation..

Radiate all of the disease...plus a margin.

Do it once on the established German protocol....


......and hopefully you can be in the high percentage of patients that can walk away and forget about this disease.....

I asked prof S. How many of his patients required more RT after initial treatment......From memory he said very few, 3 or 4 with particularly aggressive cases. A pretty good outcome considering the huge volume of patients he s seen.

My guess Callie is that if you follow your oncologists advice regarding margins, the dosage follows established German protocol and the timing is right for RT......the progression will stop and that this will be your first and last treatment for DC.......My concern and reason to contribute to this thread was to raise the issue of radiating small areas and needing unnecessary further treatment..

All the best to you

Gazza

Edited 11/20/12 09:17

callie:

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Is there a link for "The recent Phase III clinical paper by Prof. Seegenschmiedt is a large study over many years and here 12 weeks is the interval between sessions"?

My round 2 of RT is 9 weeks out and I would like to go at four weeks. Any thoughts?

Thank you. For some reason I was thinking the optimum period was four weeks and as late as 6 weeks. My hand shows zero effects from the treatment in the first round. It looks and feels exactly the same as before treatment. Should I be feeling/seeing something?