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skin cream
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12/12/2012 21:26
Lanod 
12/12/2012 21:26
Lanod 
Re: skin cream

mick9:
Lanod:
ARyan and Callie are correct in cautioning against rushing in too fast for RT threatment. It is always down to a personal decision where pros and cons all need to weighed up. I see it as a statistical issue. If you have early stage DD (Stage N) then according to latest Phase III clinical study study (this year) here are the statistictics:

Without RT: 1 in 3 chance of developing contracture within some 8 years
With RT: 1 in 30 chance of developing contracture within some 8 years

It is correct to say that some people, without treatment, might never develop contacture. It is also correct to say that if you wait for contracture then RT will be very much less effective.

So - it is a personal decision. For me it was a clear decision: I went for RT and I am delighted that I made that PERSONAL decision for myself.

This study indicates that contracture is much lower than one in 3 follow up 8.7 yaers averaged

http://www.ncbi.nlm.nih.gov/pubmed/16182060

Also this one says 1 in 20

http://www.dupuytrenfoundation.org/Natur...-Treatment.html

I am a bit confused now

Hi Mick,

Re. the discussion above I guess the confusion is derived from different definitions of contracture.

In Prof. Seegensscmiedt Phase III study, the 1 in 3 chance of developing contracture includes all progression beyond stage N (no contracture stage). So a patient progressing from Stage N to Stage N/I might have just 1 degree of contracture, or more contracture beyond 1 degree.

The links which you quote seem to imply contracture where surgical intervention is required - maybe 30 degrees or greater.

Th above is simply my obsevation - I have no special knowledge on this.

12/13/2012 07:18
wach 

Administrator

12/13/2012 07:18
wach 

Administrator

Who might consider RT?

This is a very interesting discussion. Many people can live with Dupuytren's with no problems other than a nodule in the palm or a few degrees of contracture. Therefore I don't think it would be wise to recommend getting radiotherapy to everybody with a nodule. But who would then be a good candidate? Probably we ought to have a sort of guideline. Here are a few ideas that might contribute to a future guideline:

> patients should not be too young (for risk of developing cancer later) nor too old (because their disease likely will not develop aggressively anymore)

>treating only nodules that are growing aggressively

> treating nodules only in the first year after they had been detected.

Maybe putting up something like this on our website would be useful?

Besides that, as Lanod already said, it's always a personal decision.

Wolfgang

Edited 12/13/12 09:20

12/14/2012 12:02
alcook101 
12/14/2012 12:02
alcook101 
Re: skin cream

Very interesting discussion for our health and our wallets.

From page 360 of the "Jan 2012" book
3.5% progress at the stage N - nodules and/or cords
30% progress at the N/I stage - nodules and cords up + up to 10 degrees deformation.

The problem with just getting a very small nodule treated would be - too small an area treated and more radiation needed later on.

One idea could be that the most return on the investment is right on the borderline of stage N and stage N/I, ie the worst finger can no longer raise off the table on its own on a flat table hueston table top test.

12/14/2012 12:50
wach 

Administrator

12/14/2012 12:50
wach 

Administrator

Re: skin cream

I would agree with you if the effectiveness of radiotherapy would not rapidly reduce with the time period between first detection and treatment. If you look at the bar graph on http://www.dupuytren-online.info/radiation_therapy.html, you see that if treated within the first 12 months the probaility of progression is 2%; if treated after 4 years, the probability for progression is already at 55%. Staging alone doesn't seem to tell the full story.

Wolfgang

alcook101:
Very interesting discussion for our health and our wallets.

From page 360 of the "Jan 2012" book
3.5% progress at the stage N - nodules and/or cords
30% progress at the N/I stage - nodules and cords up + up to 10 degrees deformation.

The problem with just getting a very small nodule treated would be - too small an area treated and more radiation needed later on.

One idea could be that the most return on the investment is right on the borderline of stage N and stage N/I, ie the worst finger can no longer raise off the table on its own on a flat table hueston table top test.


Edited 12/14/12 14:52

12/14/2012 14:12
alcook101 
12/14/2012 14:12
alcook101 
Re: skin cream

Good point Wolfgang about timescale after initial detection.

What was the background to your radiation treatment on your hand, stage treated, surface area treated and progression?
Which year did you have radiation treatment?

Al

12/14/2012 15:21
wach 

Administrator

12/14/2012 15:21
wach 

Administrator

Re: skin cream

I had several quickly growing nodules at various times and had several RTs which were done in Munich. All of them xrays, no electrons.

Wolfgang

alcook101:
...What was the background to your radiation treatment on your hand, stage treated, surface area treated and progression?
Which year did you have radiation treatment?

Al

12/14/2012 15:42
callie 
12/14/2012 15:42
callie 
Re: skin cream

I had the first round of RT about five weeks ago. After the first three weeks I did not notice anything differently. The last two weeks I have noticed a little drying of the skin in the Dupuytren's active areas. I can tell a great difference in feel around the very active nodule. It has been about 11 months since I first noticed this active nodule. A cord started to develop in the last three months, but no contraction.

12/14/2012 17:18
alcook101 
12/14/2012 17:18
alcook101 
Re: skin cream

Hi Wolfgang

The treatment area does not seem to be discussed in the published reports.

The area I had radiated was the same on both hands and about 9cm wide x 12cm including whole of the hand, fingers up to PIP joint - but not thumb and base of thumb and finger tips.

Al

12/14/2012 19:33
Lanod 
12/14/2012 19:33
Lanod 
Re: skin cream

alcook101:
Hi Wolfgang

The treatment area does not seem to be discussed in the published reports.

The area I had radiated was the same on both hands and about 9cm wide x 12cm including whole of the hand, fingers up to PIP joint - but not thumb and base of thumb and finger tips.

Al

Al,

Re. treatment area, in what is probably the largest published study (Seegenschmiedt et. al., year 2012) on RT treatment for Dupuytrens, involving approx. 500 patients/700 hands, the following is stated in regards to the treatment area:

"Local RT was applied depending on the individual grade and extent of DD. It was common policy in our clinic to treat the whole afflicted area of the palm including all palpable and visible nodes and cords with sufficient distal and proximal (1–2 cm) and lateral margins (1 cm)."

12/15/2012 15:45
alcook101 
12/15/2012 15:45
alcook101 
Re: skin cream

Hi Lanod

Thanks for this info.

I've added a diagram with this info to the Hamburg trip page. (But slightly simpler wording).

Al

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