[Radiotherapy in the early stage of Dupuytren's disease. The indications, technic and long-term results]

Abstract

Aim: Radiotherapy was applied in our clinic to prevent the disease progression in early stage Dupuytren's contracture. Initial response, long-term outcome, acute and late toxicity of the treatment were evaluated in a retrospective analysis.

Patients and method: Between 1982 and 1993, 96 patients (142 hands) received orthovoltage radiotherapy, which consisted of 2 radiotherapy courses with daily fractionation of 5 x 3 Gy (total dose: 30 Gy) separated by a 6 weeks interval. The Dupuytren's contracture was staged according to the classification of Tubiana et al. [38]. The initial evaluation was performed 3 months after completion of radiotherapy, while long-term outcome was analysed at last follow-up between February and April 1994. The mean follow-up was 6 +/- 2 (range 1 to 12) years. Fifty-seven patients with a follow-up of > or = 5 (median 7,5; mean 9,5 to 12) years were separately evaluated for long-term outcome, i.e. prevention of disease progression. Acute and late treatment toxicity was assessed using the RTOG/EORTC criteria.

Results: According to stage, 130 (92%) cases remained stable at 3 months follow-up, 10(7%) improved and 2 (1%) progressed. An objective reduction of symptomatic cords and nodules was achieved in 107 (75%) cases at 3 months follow-up. Moreover, 87% of the patients reported a subjective relief of symptoms. In long-term follow-up, only 16 of 142 (11%) cases had progressed according to stage. In the group with a minimum follow-up of 5 years (n = 57), 44 (77%) patients experienced no progression, while 13 (23%) progressed inside (8 cases) or outside (5 cases) of the radiotherapy field. Many "failures" could have been avoided with appropriate choice of larger safety margins included in the treated portals, however, most failures were successfully managed by a second radiotherapy or hand surgery.

Conclusion: Radiotherapy prevents disease progression for early stage Dupuytren's contracture. Thus, an otherwise necessary surgical procedure in advanced stages of Dupuytren's contracture can be avoided. Moreover, in case of disease progression despite radiotherapy a second radiotherapy or salvage operation is still feasible.