title: Patient-reported outcomes after electron radiation treatment for early-stage palmar and plantar fibromatosis.
abstract: OBJECTIVE
  Palmar and plantar fibromatosis (PPF) is a progressive connective tissue disorder of the hand/foot that often leads to debilitating functional impairment. In Europe, orthovoltage radiation therapy (RT) has been demonstrated to prevent local disease progression for up to 80% of patients with early-stage PPF. There are limited data reporting outcomes for populations outside of Europe or using electron RT.
  
  
  METHODS
  Between 2008 and 2013, 44 early-stage PPF cases received RT. RT fields involved clinically defined targets encompassing involved areas (skin changes, cords, nodules) with at least 1.5-cm margins. En face electrons (6-12 MeV) and bolus (0.5-1 cm) were selected individually. Outcomes are reported for patients who participated in an institutional review board-approved standardized questionnaire and chart review.
  
  
  RESULTS
  Thirty-three patients received 66 treatments (45 hands/15 feet and 6 reirradiations). Most frequent dose schemes were 21 Gy (3 Gy in 7 fractions) and 30 Gy (3 Gy in 10 fractions with 6- to 8-week breaks after 15 Gy). Median time to follow-up survey was 31 months. Disease progression at any location within or outside the RT treatment field occurred in 20 of 33 patients (61%). Fourteen of 60 sites (23%) developed in-field progression, but 4 sites were successfully reirradiated with final local control in 50 of 60 sites (83%). RT improved pretreatment symptoms of pain with strain at 30 of 37 sites (81%) and itch/burn sensations at 17 of 21 sites (81%). There were no reported grade ≥2 late toxicities even with reirradiation. Patient reported overall success with treatment was 31 of 33 patients (94%).
  
  
  CONCLUSIONS
  PPF is a progressive disease. En face electron RT is an effective therapy that stabilizes or improves symptoms in the majority of patients. Reirradiation can be considered as a treatment option for in-field progression. Patients report minimal toxicity and a high rate of satisfaction with treatment.
authors.affiliation: Department of Human Oncology, University of Wisconsin, Madison, Wisconsin; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia. Electronic address: jessica.moore84@hotmail.com.
authors.forename: Jessica
authors.initials: J
authors.lastname: Schuster
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Saraiya
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Tennyson
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Michele
authors.initials: M
authors.lastname: Nedelka
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Nitai
authors.initials: N
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Weiss
mesh_terms: D004583:Electrons / Q000627:therapeutic use*; D005260:Female; D005350:Fibroma / Q000473:pathology / Q000532:radiotherapy*; D005533:Foot Dermatoses / Q000473:pathology / Q000532:radiotherapy*; D006229:Hand Dermatoses / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D057566:Self Report