title: Radiation therapy for early stages of morbus Ledderhose.
abstract: 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.
authors.affiliation: Department of Radiotherapy, Klinikum Offenbach, Offenbach, Germany. Reiniheyd@aol.com.|Strahlenklinik, Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany. Reiniheyd@aol.com.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Heyd
authors.affiliation: Central Institute of Radiology, Municipal Hospitals, Frankfurt/Main-Höchst, Germany.
authors.forename: Anne Pia
authors.initials: AP
authors.lastname: Dorn
authors.affiliation: Radiotherapeutic Practice at the Municipal Hospitals, Frankfurt/Main-Höchst, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Herkströter
authors.affiliation: Department of Radiotherapy and Oncology, University Hospital, Frankfurt/Main, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Rödel
authors.affiliation: Central Institute of Radiology, Municipal Hospitals, Frankfurt/Main-Höchst, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Müller-Schimpfle
authors.affiliation: Department of Radiotherapy and Oncology, University Hospital, Frankfurt/Main, Germany.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Fraunholz
mesh_terms: 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