Vikingorigins:

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Hi, I am back from getting RT in Hamburg and got the first treatment for the half of my left hand. The right hand is affected but more recently, like the feet and those 3 other members are under observation for now. I should say that the disease progressed very rapidly, spread in all members and this frightens me a lot. Dr. S says the disease might stop for non treated members and areas after the first RT in the left hand. It seems that this does happen. I appreciate very much his prudence.
It makes me think that if the disease progresses with nodules in the non-treated hand, or in non-treated areas of the treated hand, I can always get RT for new areas. The downside is unaesthetic nodules with which I can easily live.
The feet are different though. If RT could prevent new nodules even to appear that would be better because the nodules can seriously limit the function and be very painful while walking. Earlier RT for LD is a lot more appealing.
I guess the questioning for which I would like some feedback from this forum is this one: once we know that DD is in both hands, and we have itching, pain and burning in the feet, is it still too early to irradiate the foot ? Why ? Is it a because RT would not work yet ? or is it a ethical question not to irradiate a part where nodules are not already there ?
Thank you for your thoughts.

In the recent book on Dupuytrens ( can be read online:

http://www.springerlink.com/content/978-...6312&page=1 )

on pages 351 and 352 Prof. Seegenschmiedt outlines the biological basis for radiation treatment of DD and LD. He clearly needs to believe that highly proliferating fibroblasts exist on the target site, since such fibroblasts (and associated myofibroblasts, growth factors etc.) are the predominant radiosensitive targets. Thus if the disease progression seems to be dormant for some time, radiation will not be effective as there is not evidence of high proliferation of fibroblasts. Likewise, I assume, is very early stage DD, if the disease is not yet showing evidence of high proliferation (e.g. a nodule is established and is growing) then biological target is not yet ready to be ‘attacked’ by the ionizing radiation.

At least this seems to the theory from my understanding.

This an excellent discussion and it hits exactly where RT should not be applied:

TOO EARLY

--> No progression over the last 6 - 12 months
--> No palpable nodules or cords, just "symptoms"
--> No function deficit : Hands --> no limitation of stretching the fingers;
Feet --> No walking difficulties

TOO LATE

--> Nodules and Cords have a "very hard" consistency (Prof. Seegenschmiedt uses a 4-grade scale)
--> Function deficit is advanced --> fingers cannot be stretsched completely (about 30°)


I got both feet irradiated first ; one was already operated and did recur within 4 months; at the same time also early stage Dup's was diagnosed in both hands by Prof. S., but he didn't want to treat them unless they became "active" which occured for the right hand after an injury which led to progression and RT of my right hand 4 years after the RT of both feet; the left hand is still in a "stable condition" with a few soft nodules but without apllied RT. If it becomes "active" I can still go and get RT at Hamburg as I am living in Germany ...

I think the prudence of selecting the "right time" for RT is clearly on the Prof's side, as he has seen hundreds if not even more than thousand hands for evaluation in the past two decades:

I would strongly believe the recommendation of Prof. Seegenschmiedt and stay away from any type of "prophylactic RT" without evidence of disease activity!

LARRY

Edited 08/19/12 17:50

Are you saying that once you have had one area on hand or foot with RT you CANNOT have it again in the same spot?

It would be interesting to see, in cases where the disease has progressed after RT, whether new nodules appeared inside irradiated areas or outside. If it is always outside, it would support some sort of preventive effect of RT.