[Radiation therapy for Morbus Ledderhose -- indication and clinical results].
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.


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 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.
Seegenschmiedt
Michael Heinrich
MH
Klinik für Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus, Essen, Deutschland. heinrich.seegenschmiedt@krupp-krankenhaus.de
Attassi
Mared
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002648:Child; D003286:Contracture / Q000175:diagnosis; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D004387:Dupuytren Contracture / Q000175:diagnosis; D005260:Female; D005350:Fibroma / Q000175:diagnosis / Q000532:radiotherapy*; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000175:diagnosis / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D017060:Patient Satisfaction; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D013997:Time Factors; D016896:Treatment Outcome