Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Betz
Nicolas
N
Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
Ott
Oliver J
OJ
Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany. oliver.ott@uk-erlangen.de.|Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany. oliver.ott@uk-erlangen.de.
Adamietz
Boris
B
Radiologic Institute, University Hospital Erlangen, Erlangen, Germany.
Sauer
Rolf
R
Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
Fietkau
Rainer
R
Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
Keilholz
Ludwig
L
Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.|Department of Radiotherapy, Klinikum Bayreuth GmbH, Erlangen, Germany.
D000328:Adult; D000368:Aged; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D004387:Dupuytren Contracture / Q000145:classification / Q000175:diagnosis / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011855:Radiodermatitis / Q000209:etiology; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome