Optimization of radiotherapy for Dupuytren's disease

Purpose: Radiotherapy prevents progression of Dupuytren's contracture. Here in, 1-year results of a prospective randomized trial comparing 2 different dose concepts are presented. Patients and Methods: 129 patients (67 males, 62 females) were included in the study with a minimum 1-year follow-up: 69 had bilateral and 60 unilater al involvement of Dupyutren's disease accounting for 198 irradiated hands. According to Tubiana, 73 hands had Stage N, 61 Stage N/I (less than or equa l to 10 degrees flexion deformity), 59 Stage I(11 to 45 degrees) and 5 Stag e II disease (46 to 90 degrees). Radiotherapy was randomly delivered: group A (63 patients/95 hands) received 10 times 3 Gy (total: 30 Gy) in 2 series teach 5 times 3 Gy) separated by 8 weeks; group B (66 patients /103 hands) received 7 times 3 Gy (total: 21 Gy) within 2 weeks. Orthovoltage radiothe rapy (120 kV) with 40 cm standard cones and individual shielding was applie d. Patient and disease parameters were equally distributed in both groups. Evaluation (toxicity, efficacy) was performed at 3 and 12 months with regar d to subjective (patient's opinion) and objective parameters (palpation, me asurements, comparative photographs - physician). Results: Acute toxicity was minimal: 76 (38%) hands had skin reactions CTC Grade 1, 12 (6%) CTC Grade 2. Chronic side effects (dryness, skin atrophy, change of sensation, LENT Grade 1) occurred in 9 (5%) hands without differe nces between treatment groups. At 3 and 12 months follow-up, subjective sym ptoms and objective signs, nodules and cords, were reduced in both groups ( p < 0.01) with no differences between groups: a total of 110 (55%) hands (g roup A: 55, group B: 55) regressed, 74 (37%) hands (group A: 35: group B: 3 9) were stable. Overall and mean number of nodules, cords and skin changes decreased at 3 and 12 months. 16 of 198 (8%) hands (group A: 7; group B: 9) progressed at 12 months follow-up ("treatment failure"); at 1 year, 7 of 6 0 patients with unilateral Dupyutren's disease required prophylactic radiot herapy for the contralateral hand due to disease progression, Conclusions: Prophylactic radiotherapy reduces symptoms and prevents diseas e progression in early-stage Dupyutren's disease. Both treatment concepts a re well-tolerated and equally effective. Acute toxicity is slightly increas ed with treatment concept B (7 times 3 Gy), while chronic sequelae are Low in both treatment groups. Long-term evaluation with follow-up of more than 5 years has to be awaited to recommend one or the other dose concept.