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08/13/2010 13:22
SamA 
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08/13/2010 13:22
SamA
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RT for Ledderhose
I wonder if there are any published and / or generally accepted protocol guidelines for RT for the treatment of Ledderhose? In otherwords, what kind of RT at what intensity, and for how many treatments. If RT has been successfully done in La Jolle, CA, there is no reason it cannot be done in Dallas, TX, Atlanta, GA or anywhere else if the proper protocol is followed.
You would think that if RT is as successful as we are lead to believe, the Podiatrist Association would come up with an RT protocol to assist those with LD.
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08/13/2010 20:19
flojo 
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08/13/2010 20:19
flojo
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Re: RT for Ledderhose
Quote:
I wonder if there are any published and / or generally accepted protocol guidelines for RT for the treatment of Ledderhose? In otherwords, what kind of RT at what intensity, and for how many treatments. If RT has been successfully done in La Jolle, CA, there is no reason it cannot be done in Dallas, TX, Atlanta, GA or anywhere else if the proper protocol is followed.
You would think that if RT is as successful as we are lead to believe, the Podiatrist Association would come up with an RT protocol to assist those with LD.
I agree that a radiologist knows, or should know radiation, and can research and consult with other radiologists about the specific protocol for Ledderhose or whatever else. Others on this Forum have found their own local radiologists who did the homework and provided RT successfully. I don't know for sure, but I believe that Dr. T at Scripps would be very willing to consult with other radiologists. Radiology is radiology. If they can radiate for cancer specific to every type of cancer and every different patient, RT for non-cancerous conditions should be much less complex.
As for podiatrists, I talked with mine about how RT was effective for my Dupuytren's and that RT has been successful for Ledderhose. Her reaction was clearly one of not wanting to hear about it. It would certainly cut into their surgery business/practice. Hopefully, other podiatrists will want to tell their patients for RT as an option and give them referrals for evaluation. I live in a fairly small town, so I'm educating any medical practitioner I come in contact with. In contrast to my podiatrist, all the others are very happy to see the results and have the optional treatments to tell their patients about.
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08/16/2010 17:59
SamA
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08/16/2010 17:59
SamA
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Re: RT for Ledderhose
Sounds like you need a new podiatrist.
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08/17/2010 04:18
flojo
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08/17/2010 04:18
flojo
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Re: RT for Ledderhose
SamA,
You got that right!
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08/17/2010 08:14
Larry
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08/17/2010 08:14
Larry
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RT for Ledderhose - Abstract of Full Article by Prof. Seegenschmiedt
SamA:
I wonder if there are any published and / or generally accepted protocol guidelines for RT for the treatment of Ledderhose? In otherwords, what kind of RT at what intensity, and for how many treatments. If RT has been successfully done in La Jolle, CA, there is no reason it cannot be done in Dallas, TX, Atlanta, GA or anywhere else if the proper protocol is followed.
You would think that if RT is as successful as we are lead to believe, the Podiatrist Association would come up with an RT protocol to assist those with LD.
In the National Library of Medicine (PubMed) a description of Radiotherapy for Morbus Ledderhose is
given with regard to Prof. Seegenschmiedt, who is treating patients in Hamburg (including myself):
Unfortunately the paper is written in GERMAN language, but may be Prof. Seegenschmiedt may have a full text in
English available ? We should ask him about the exact schedule, dose etc. --> Here is the abstract which I got from PubMed:
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Strahlenther Onkol. 2003 Dec;179(12):847-53.
[Radiation therapy for Morbus Ledderhose -- indication and clinical results]
[Article in German]
Seegenschmiedt MH, Attassi M.
Klinik für Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus, Essen, Deutschland. heinrich.seegenschmiedt@krupp-krankenhaus.de
Abstract
BACKGROUND: Morbus Ledderhose (ML) is a rare hyperproliferative disorder of the plantar aponeurosis which is similar in its clinical course to Morbus Dupuytren (MD). We examined whether radiotherapy (RT) can effect symptoms and prevent disease progression.
PATIENTS AND METHODS: From June 1996 to December 2001, 25 patients (12 female/13 male) aged 9-76 (median: 56) years had radiotherapy (RT) for symptomatic ML. Follow-up (FU) was at least 1 year. 36 feet (16 right/20 left) were treated, as eleven patients had bilateral disease. Twelve (48%) patients had MD. There were 63 nodules (with 0,5-6,5 cm diameter) on all feet and 20 cords (with 1-4 cm length) on 13 (52%) feet prior to RT. 21 (84%) patients had one or more signs: 14 (56%) severe local pain, eight (32%) walking difficulties, twelve (48%) other symptoms, pressure or tension sensation. The RT field involved all nodules and cords plus safety margin. Two RT-series were applied (each 5 times 3 Gy in 1 week) separated by 8-12 weeks up to a total dose of 30 Gy. Evaluation was performed at the end of RT, after 3 and 12 months FU and in December 2002. The primary endpoint was prevention of disease progression and avoidance of surgery. Secondary endpoints were objective changes of morphological and functional parameters and patient's satisfaction measured on a visual analogue scale (VAS).
RESULTS: With a median FU of 38 (12-67) months no patient experienced progression or underwent surgery: 11 of 36 (44%) feet had a reduced number (overall: -16) or size of nodules, 7 of 13 (54%) feet had a reduced number (overall: -9) or length of cords; gait was improved in six of twelve (50%) feet; pain was reduced or had completely disappeared in 9 of 15 (60%) feet, and other symptoms disappeared in 8 of 18 (44%) symptomatic feet. 20 (80%) patients regarded 28 of 36 (78%) treated feet as improved and 8 (22%) in stable condition. The median relative improvement stated by patients on the VAS was 50% (0-100%). Treatment side effects were minimal: During and within 3 months of the RT course only a slight erythema (CTC 1 degrees ) was seen in five treated lesions, while dry skin changes within the RT portal were observed in three cases (11%) in long term FU (> 12 months).
CONCLUSIONS: Radiotherapy is effective in treating ML and may prevent otherwise necessary surgical interventions. Nodules, cords and symptoms regress, but long-term outcome of at least 5 years has to be awaited. Prospective phase III studies should confirm these results.
PMID: 14652674 [PubMed - indexed for MEDLINE]
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Edited 08/17/10 11:15
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08/18/2010 13:44
SamA
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08/18/2010 13:44
SamA
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Re: RT for Ledderhose
Larry, thanks for your response. The study you presented ended in December 2001 with apparent successful results.
In addition, another study which has a liks on this web site (see below for link) presents a study that ended in 2007 for DD and LD which was appparently sucessful.
Plus, there have been several people on the site say that RT has helped them.
This brings us to the question, why has RT not become a universally accepted and generally prescribed treatment for LD?
http://www.dupuytren-online.info/ASSH_2006/M-Dupuytren-ASSH2006_Internet_files/frame.htm#slide0018.htm
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08/18/2010 17:15
SamA
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08/18/2010 17:15
SamA
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Re: RT for Ledderhose
Thanks, Wolfgang. I am sending this to my podiatrist today.
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08/19/2010 17:14
Larry
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08/19/2010 17:14
Larry
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Re: RT for Ledderhose
SamA:
Thanks, Wolfgang. I am sending this to my podiatrist today.
Thanks for these updated figures from the German study by Prof. Seegenschmiedt and his group.
These data are really encouraging and should be mailed to all podiatrists ...
will Prof. Seegenschmiedt publish these data in a PubMed cited journal ? This would help to convince
the competitive other medical disciplines ...
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08/19/2010 18:14
wach  Administrator
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08/19/2010 18:14
wach Administrator
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Re: RT for Ledderhose
The conference proceedings will be published as a peer reviewed book appearing in 1H2011.
Wolfgang
Larry:
Thanks for these updated figures from the German study by Prof. Seegenschmiedt and his group.
These data are really encouraging and should be mailed to all podiatrists ...
will Prof. Seegenschmiedt publish these data in a PubMed cited journal ? This would help to convince
the competitive other medical disciplines ...
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