Radiation therapy for early stages of morbus Ledderhose.
OBJECTIVE
To evaluate the efficacy of radiation therapy (RT) in the treatment of early stages of benign plantar fibromatosis (Morbus Ledderhose [ML]).


METHODS
From 2003 to 2008, 24 patients (33 sites) with a mean age of 52 years received RT for symptomatic ML. Prior to RT, 19 patients complained of pain and 15 had walking difficulties. 21 patients (28 sites) were irradiated with orthovoltage X-rays and three (five sites) received electron-beam irradiation. The RT protocol consisted of five weekly fractions of 3.0 Gy (15 Gy), repeated after 6 weeks to a total dose of 30 Gy in 20 patients (28 sites). In four patients (five sites), two single fractions of 4.0 Gy were applied, repeated at intervals of 4 weeks to total doses of 24-32 Gy. Primary study endpoints were the prevention of disease progression and the avoidance of a surgical intervention. Secondary endpoints were pain relief, improvement of gait, and patients' subjective satisfaction measured with a linear analog scale (LAS).


RESULTS
After a median follow-up of 22.5 months, none of the patients experienced a progression of number and size of the lesions or the clinical symptoms. In eleven sites (33.3%) complete remission of cords or nodules occurred, in 18 (54.5%) a reduced number or size was noted, and four sites (12.1%) were unchanged. Pain relief was achieved in 13/19 patients (68.4%), and an improvement of gait abnormalities was noted in 11/15 patients (73.3%). The patients' subjective satisfaction measured by means of the LAS revealed a median improvement of 3.5 points in 22/24 patients (91.6%). Skin or soft tissues toxicities RTOG grade > 2 were not noted.


CONCLUSIONS
RT is effective for treatment of the early stages of ML and may obviate the need for a surgical intervention. Long-term follow-up studies including a larger number of patients are required to define the role of RT in the management of this disorder.
Heyd
Reinhard
R
Department of Radiotherapy, Klinikum Offenbach, Offenbach, Germany. Reiniheyd@aol.com.|Strahlenklinik, Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany. Reiniheyd@aol.com.
Dorn
Anne Pia
AP
Central Institute of Radiology, Municipal Hospitals, Frankfurt/Main-Höchst, Germany.
Herkströter
Markus
M
Radiotherapeutic Practice at the Municipal Hospitals, Frankfurt/Main-Höchst, Germany.
Rödel
Claus
C
Department of Radiotherapy and Oncology, University Hospital, Frankfurt/Main, Germany.
Müller-Schimpfle
Marcus
M
Central Institute of Radiology, Municipal Hospitals, Frankfurt/Main-Höchst, Germany.
Fraunholz
Ingeborg
I
Department of Radiotherapy and Oncology, University Hospital, Frankfurt/Main, Germany.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004387:Dupuytren Contracture / Q000532:radiotherapy*; D005260:Female; D005350:Fibroma / Q000532:radiotherapy*; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000532:radiotherapy*; D005684:Gait / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000528:radiation effects; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage