Hi All,

Dr Kline here. I am a big proponent for radiating dupuytrens and have been doing so for the past four years. I have a radiation oncologist here in Boise who has had experience with e-beam radiation and dupuytrens disease during her residency and handles my local cases. Over the years, I have built up an extensive network of radiation oncologists throughout the western USA because a large portion of my patients live outside of Idaho and want to have this done in their hometown.

I have found the radiation oncologists informed and receptive to performing radiation for dupuytrens disease, they all seem to know about it! Initially, I was recommending this only on early active disease (node based), but as I developed more experience with NA, I found that the female patients were having a faster rate of recurrence then males. My local radiation oncologist and I decided to start radiating dupuytrens after NA release in women only if they had stage II or less, and had a perfect release status post NA (flat palm and good extension in all fingers). We do not have 5 year data on this yet but so far, so good - only one failure so far (recurrence). Over the last 2 years we've started adding men to the protocol. We try to radiate the hand within 72 hours after release (NA), and follow the standard German protocol. Plans are to get a paper out on this in 2 years after more data and patient follow up. The goal here is to stop progression of the disease, or at least slow it down.

As a side note, I have had my own hands treated exactly this way, with an early release of both little fingers followed by radiation. I found the side effects very tolerable, one day of redness and some dryness of the palm. It has been 2 years post-radiation for me with no progression of my dupuytrens. If your age is greater than 40 the risk of cancer is virtually zero.

Excellent, many thanks for posting that

Cambidgeshire, UK.

Dear Wach,

I have had the same discussions with my radiation oncologist. When consulting with my patients I echo the results of the Betz paper and let them make up their own minds. All patients must undergo evaluation by the radiation oncologist who also thoroughly reviews the pros and cons of radiation therapy with them.

What happens when you cut cords via NA and return hands to stage N? If the disease returns, does this indicate activation of the proliferation fibroblasts? My radiation oncologist says yes and believes that radiation is beneficial. I personally do not believe that by returning a stage I or II to stage N that the benefits from radiation will be as effective as radiation of pristine 0, N or N/1. That being said, so far the women that I have radiated post-NA have done very well. I will be getting a paper out on this once I have sufficient data out to at least the 5 years point, which is soon.

So far I have had 2 patients needing redo after their NA-plus-radiation, and in both cases the cords that reformed seem so weak that I felt that forced mechanical extension of the joint would have been as effective as NA for this secondary release.

I posted Betz paper to show the low cancer risk and benefits for early disease. There is also a paper out there (I can not find it for the life of me---European study) where they performed radiation after z-plasty. The recurrence rate was decreased by approximately 17-18%. This may not sound significant, but if there was a slight decrease in recurrence after the active tissue was removed, think of the benefits to tissue that is actually sensitive to radiation. Studies are needed to verify, and that's what I am trying to do.

Thanks to Wolfgang and Dr. Kline for this discussion about RT. As it is with everything else about this disease, every hand is different with regards to effectiveness of RT. We need the long term research. Thanks, Dr. Kline for keeping records and posting other studies.

Even for myself with initial results being very successful in stopping or slowing the progression, I am still in a wait and see mode. All I know for sure is that I had nodules continually developing and progressing in all 4 quadrants of my palm. After RT last July, many nodules reduced or went away, some got softer and no new nodules have formed in the radiated area. I am hopeful that it will last. We'll see.

Just wanted to say thank you to Dr. Kline for taking time out of his schedule to call me today even though he has never seen me. I sent him pics of my hand and explained the dilemma of having the nodule in my pinkie that is contracting it and no apparent cord. He called me the next day and we spoke for quite a while and I believe I will be going to see him and hopefully get radiation treatment. He is so nice I felt like I was speaking to a long time friend! Maybe, because he has Dupuytrens himself, he is able to empathize with us.

Anyway, thanks, Doctor Kline, I appreciate it.