Radiotherapy for prevention of disease progression in early-stage Dupuytren's contracture: Initial and long-term results

Purpose: Radiotherapy (RT) was given to prevent disease progression in early-stage Dupuytren's contracture, Initial response, long-term outcome, and treatment toxicity were evaluated. Methods: Between 1982 and 1993, 96 patients (142 hands) received orthovoltage RT, which consisted of two courses with daily fractionation of 5 x 3 Gy (total dose 30 Gy) separated by a 6-week interval, The extent of disease was staged according to the classification of Tubiana et al., Initial evaluation was performed 3 months after completion of RT; long-term outcome was analyzed at last follow-up (i.e., between February and April 1994), The mean follow-up was 6 +/- 2 (range 1-12) years, Fifty-seven patients with a minimum follow-up of 5 (median 7.5; mean 9.5-12) years were separately evaluated for long-term outcome (i.e., prevention of disease progression), Acute and late treatment toxicity was assessed using the Radiation Therapy Oncology Group/EORTC criteria. Results: According to stage, 130 cases (92%) remained stable at 3 months follow-up, 10 improved (7%), and 2 progressed (1%), An objective reduction of symptomatic cords and nodules was achieved in 107 cases (75%) at 3 months follow-up, Moreover, 87% of the patients reported a subjective relief of symptoms, In long-term followup, only 16 of 142 cases (11%) had progressed according to stage, In the group with minimum follow-up 5 years (n = 57), 44 patients (77%) experienced no disease progression, whereas 13 progressed (23%) inside [8 cases (14%)] or outside [5 cases (9%)] of the RT field, Most failures could have been avoided with appropriate choice of larger safety margins included in the treated portals; however, the failures outside were still amenable for another RT course. Conclusion: Radiotherapy is effective to prevent disease progression for early-stage Dupuytren's contracture, Thus, it helps to avoid an otherwise necessary surgical procedure which is performed in adavanced stages of Dupuytren's contracture. Copyright (C) 1996 Elsevier Science Inc.