Treatment of Dupuytren's Disease with Post-Interventional Radiotherapy

Abstract

<h3>Purpose/Objective(s)</h3> Ongoing clinical studies are currently testing the benefit of radiotherapy (RT) in Dupuytren Disease (DD) early after interventions used to release a contracture in order to reduce the chances of re-contracture and prevent non-operated areas forming new contractures. Those interventions are needle fasciotomy (NF), collagenase injection (CI) and limited fasciectomy (LF). This phase I-II study summarizes patients with advanced DD treated between 2005 - 2020 using post-interventional RT with follow-up of at least 1 year (mean 5.5, range 1 – 15 years). <h3>Materials/Methods</h3> Patients underwent RT at four different practices organized by a single radiation oncologist (HS) and were divided in two groups: Group A: Early post-interventional RT (given 2-12 weeks after intervention) A1, post-NF: n=25 patients, Male: Female ratio = 15:8; age range 38–73y, 29 hands treated A2, post-CI: n=7: M: F = 4:3, age 41–74y, total 7 hands A3, post-LF: n=19: M: F = 11:8, age 35-71y, total 19 hands Group B: Delayed post-interventional RT (given 4 to 48 months after intervention) B, delayed RT: n=48, M: F = 30:18, age 31–76, total 53 hands All groups received two series of 15Gy in daily fractions of 5 × 3Gy with a 10-12 weeks interval up to 30Gy total dose in 10 fractions. All groups apart from group A3 received RT in two RT-series to the whole palm for both phases while in group A3 the 2nd RT series excluded the LF site. RT Timing: In groups A1 and A2, RT was started 2-4 weeks after intervention. In group A3 RT was started 6-12 weeks after intervention after local healing was completed. In group B, RT was started at least 4 months after intervention. The international "DD progression" criterion was used and defined as increased angulation deficit of at least 20 degrees in any of the involved fingers. Proven progression was categorized as either within or outside the previously operated area. <h3>Results</h3> Long-term functional stability w/o progression was evaluated in 12-2020 and achieved in 83% of Group A1 hands, in 57% of group A2, 90% in group A3, and 86% hands in group B. Minor progression with functional change of up to 10 degrees after RT occurred in 32/108 (30%) and up to 20 degrees in 15/108 (14%) hands. Symptoms such as pain, burning and itching were reduced in 57 of 73 (78%) affected pts. Cosmetic and functional outcome were judged to be "excellent" in 26 (24%), "good" in 38 (35%), "satisfactory" in 17 (16%) and "poor" or "unsatisfactory" in 27 (25%) sites. RT Side effects were long-term dryness in 43 of 108 (40%) sites; no deep wounds or ulcers or post-interventional infections were observed. <h3>Conclusion</h3> This is the first clinical study published demonstrating that post-interventional RT is an effective and safe addition to minimal non-invasive (NF and CI) and limited invasive (PNF) procedures to preserve improvements in hand function after intervention. Further controlled clinical studies supported by IORBC are required to optimize RT indication, specific selection criteria, interdisciplinary collaboration and applied RT dose concepts.