Radiotherapy for prevention of disease progression in early-stage Dupuytren's contracture: initial and long-term results.
OBJECTIVE
Radiotherapy (RT) was given to prevent disease progression in early-stage Dupuytren's contracture. Initial response, long-term outcome, and treatment toxicity were evaluated.


METHODS
Between 1982 and 1993, 96 patients (142 hands) received orthovoltage RT, which consisted of two courses with daily fractionation of 5 x 3 Gy (total dose 30 Gy) separated by a 6-week interval. The extent of disease was staged according to the classification of Tubiana et al.. Initial evaluation was performed 3 months after completion of RT; long-term outcome was analyzed at last follow-up (i.e., between February and April 1994). The mean follow-up was 6 +/- 2 (range 1-12) years. Fifty-seven patients with a minimum follow-up of 5 (median 7.5; mean 9.5-12) years were separately evaluated for long-term outcome (i.e., prevention of disease progression). Acute and late treatment toxicity was assessed using the Radiation Therapy Oncology Group/EORTC criteria.


RESULTS
According to stage, 130 cases (92%) remained stable at 3 months follow-up, 10 improved (7%), and 2 progressed (1%). An objective reduction of symptomatic cords and nodules was achieved in 107 cases (75%) at 3 months follow-up. Moreover, 87% of the patients reported a subjective relief of symptoms. In long-term follow-up, only 16 of 142 cases (11%) had progressed according to stage. In the group with minimum follow-up 5 years (n = 57), 44 patients (77%) experienced no disease progression, whereas 13 progressed (23%) inside [8 cases (14%)] or outside [5 cases (9%)] of the RT field. Most failures could have been avoided with appropriate choice of larger safety margins included in the treated portals; however, the failures outside were still amenable for another RT course.


CONCLUSIONS
Radiotherapy is effective to prevent disease progression for early-stage Dupuytren's contracture. Thus, it helps to avoid an otherwise necessary surgical procedure which is performed in adavanced stages of Dupuytren's contracture.
Keilholz
L
L
Department of Radiation Oncology, University Erlangen-Nuremberg, Germany.
Seegenschmiedt
M H
MH
Sauer
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004387:Dupuytren Contracture / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure