Nicolas Betz1, Oliver J Ott2,3, Boris Adamietz4, Rolf Sauer1, Rainer Fietkau1, Ludwig Keilholz1,5. 1. Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany. 2. Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany. oliver.ott@uk-erlangen.de. 3. Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany. oliver.ott@uk-erlangen.de. 4. Radiologic Institute, University Hospital Erlangen, Erlangen, Germany. 5. Department of Radiotherapy, Klinikum Bayreuth GmbH, Erlangen, Germany.
Abstract
BACKGROUND AND PURPOSE: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. PATIENTS AND METHODS: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. RESULTS: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. CONCLUSION: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a "salvage" operation is still feasible.
BACKGROUND AND PURPOSE: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. PATIENTS AND METHODS: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. RESULTS: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. CONCLUSION: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a "salvage" operation is still feasible.
Authors: H H Kampinga; M A W H Van Waarde-Verhagen; A J Van Assen-Bolt; B Nieuwenhuis; H P Rodemann; K R Prowse; M H K Linskens Journal: Int J Radiat Biol Date: 2004-05 Impact factor: 2.694
Authors: Latha Satish; William A LaFramboise; David B O'Gorman; Sandra Johnson; Benjamin Janto; Bing Siang Gan; Mark E Baratz; Fen Z Hu; J Christopher Post; Garth D Ehrlich; Sandeep Kathju Journal: BMC Med Genomics Date: 2008-04-23 Impact factor: 3.063
Authors: M Heinrich Seegenschmiedt; Oliver Micke; Marcus Niewald; Ralph Mücke; Hans Theodor Eich; Jan Kriz; Reinhard Heyd Journal: Strahlenther Onkol Date: 2015-03-10 Impact factor: 3.621
Authors: Liaquat S Verjee; Jennifer S N Verhoekx; James K K Chan; Thomas Krausgruber; Vicky Nicolaidou; David Izadi; Dominique Davidson; Marc Feldmann; Kim S Midwood; Jagdeep Nanchahal Journal: Proc Natl Acad Sci U S A Date: 2013-02-19 Impact factor: 11.205
Authors: Reinhard Heyd; M Heinrich Seegenschmiedt; Dirk Rades; Cornelia Winkler; Hans T Eich; Frank Bruns; Georg Gosheger; Normann Willich; Oliver Micke Journal: Strahlenther Onkol Date: 2010-07-29 Impact factor: 3.621
Authors: Franz Rödel; Benjamin Frey; Katrin Manda; Guido Hildebrandt; Stephanie Hehlgans; Ludwig Keilholz; M Heinrich Seegenschmiedt; Udo S Gaipl; Claus Rödel Journal: Front Oncol Date: 2012-09-25 Impact factor: 6.244