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RT following surgery
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11/11/18 09:20
stephenp 
11/11/18 09:20
stephenp 
RT following surgery

My 67 yo brother has just had surgery on one hand after he refused my suggestion he try RT. He is delighted with the surgery outcome, being able to place his hand flat on a table for the first time in about 10 years.

I had RT on both hands about 7 years ago and the progression has essentially stopped with only one minor episode after RT.

When I spoke to him today he asked me if there was any information on the use of RT after surgery. Has anyone any experience of this and are there any studies?

I suspect not as RT still seems to be considered an "untested" treatment, despite the good supporting data.

I do know that RT post-surgery should only be considered well after healing is completed.

Cheers

Stephen

11/11/18 10:20
Stefan_K. 
11/11/18 10:20
Stefan_K. 

Re: RT following surgery

Hi Steven.

Whether RT for DD is considered untested or effective seems to depend on how one reads the data and on how open doctors are to facts that emerged after they finished their studies. German social security pays for it, so must consider it tested and effective enough.

RT after surgery probably only makes sense if there are signs the desease continues, such as the rapid growth of new nodules, or of nodules or if cords which were awoken by surgery.

How is your brother's other hand, though?

Stef

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

11/11/18 10:20
spanishbuddha 

Administrator

11/11/18 10:20
spanishbuddha 

Administrator

Re: RT following surgery

You had an older thread https://www.dupuytren-online.info/Forum_...-na-0_2167.html discussing this where Wolfgang suggested studies were underway.

This was also discussed on one of the FB groups but with no conclusion, but the main point, as best I can recall, is that radiotherapy following surgery (adjuvant radiotherapy) for various types of cancer, also some other benign conditions is standard treatment with many outcome studies. As one example of the latter https://www.ncbi.nlm.nih.gov/pubmed/9529555

11/12/18 00:42
stephenp 
11/12/18 00:42
stephenp 
Re: RT following surgery

Thank you for the link which is very interesting.

Yes, I did ask this question previously. As I recall several people were considering this option so I am interested in hearing from anyone who has followed this path. What was the outcome? How long after surgery? Were there any problems? Was it hard to convince their practitioner?

To me this makes intuitive sense and I think it makes scientific sense provided healing is complete. RT may slow or stop any remodeling of scar tissue so timing may be critical. However remodeling may not be "normal" anyway.

My brother has both hands affected with a contraction in the other untreated hand.

Cheers

Stephen

Edited 11/12/18 00:45

11/12/18 00:55
Scarlettnova 
11/12/18 00:55
Scarlettnova 
Re: RT following surgery

I belong to a FB group DART - Dupuytren’s Advocates for Radiation Therapy. They have much information to offer with posts of RT treatment, list of Radiation oncologists who do RT and much more. Highly recommend joining to keep up. Will answer your questions too. I had hand surgery recently because doctor never told me about the RT treatment! I would have certainly done RT over surgery if I had known. I am already planning ahead for RT on my surgery hand as I figure it will be back or the other one will develop nodules.

You might find this website helpful.

https://www.thedupuytrenspractice.com/ra...ytrens-disease/

11/12/18 08:07
Stefan_K. 
11/12/18 08:07
Stefan_K. 

Re: RT following surgery

Hi Steven. Your brother could also look into RT following an NA procedure on the contracted hand.

Stef

11/12/18 08:50
wach 

Administrator

11/12/18 08:50
wach 

Administrator

Re: RT following surgery

Please note that lists of RT concologists are not only available on Facebook but also on this site https://www.dupuytren-online.info/radiotherapy_clinics.html and, specifically for the UK, on the website of the British Dupuytren's Society http://dupuytrens-society.org.uk/treatme...-organisations/ .

Wolfgang

Scarlettnova:
I belong to a FB group DART - Dupuytren’s Advocates for Radiation Therapy. They have much information to offer with posts of RT treatment, list of Radiation oncologists who do RT and much more. Highly recommend joining to keep up. Will answer your questions too. I had hand surgery recently because doctor never told me about the RT treatment! I would have certainly done RT over surgery if I had known. I am already planning ahead for RT on my surgery hand as I figure it will be back or the other one will develop nodules.

You might find this website helpful.

https://www.thedupuytrenspractice.com/ra...ytrens-disease/

11/23/18 00:00
Prof.Seegenschmiedt 
11/23/18 00:00
Prof.Seegenschmiedt 

Re: RT following surgery

Radiotherapy after Surgery can be divided in two categories of indication (= justified clinical application).

(1) DELAYED POSTOPERATIVE RADIOTHERAPY

The performance of radiotherapy for postoperative relapse / progression of Dupuytren Disease (DD) after a previous minimal invasive surgical procedure (PNF) or open surgery: radiotherapy may be only applied in the "early phase" when new nodules - even outside the operated area - are developing and the function deficit of the involved fingers is less than 10 - 30° (Table Top Test !) - Radiotherapy may delay the progression, but there is still no prospective long-term literature data available on this experimental approach

--> PubMed:https://www.ncbi.nlm.nih.gov/pubmed/?ter...ve+radiotherapy

(2) EARLY POSTOPERATIVE RADIOTHERAPY

This indication is recently under clinical investigation and still not standard care. The principle idea and concept is to preserve the regained full function of the involved finger rays after a first operation (e.g. for a stage II disease = with about 90° bended finger) AND protect the uninvolved hand palm area from a "triggered progression" of DD.

In a multicenter study this approach is currently tested in a double-blind randomized study against sham treatment by Dr Jarad Martin, radiation oncologist, Genesis CancerCare, Newcastle NSW AU 2017.

(3) My personal experience with delayed postoperative radiotherapy (1) involves about 120 patients, while my current experience with selected patients with early postoperative radiotherapy involves about 35 patients since 2014. The "immediate postoperative RT" is applied between 4 - 6 weeks post-operatively after an open procedure with uncomplicated healing process. The radiation field encompasses the finger rays D2 (index finger) to D5 (little finger); the applied dose concept is 5 x 3Gy within one week, but NO second RT series. I am in the process to collect the follow-up data and plan to present this initial experience in 2019.

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With gratitude for all affected patients & medical colleagues who help to advance patient care. Prof. S.

Edited 12/02/18 15:18

11/23/18 00:22
stephenp 
11/23/18 00:22
stephenp 
Re: RT following surgery

Thank you for the comprehensive and valuable information.

Regards

Stephen

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