Radiation therapy (radiotherapy) of Morbus Dupuytren and Ledderhose

Radiation therapy (radiotherapy) is a non-surgical treatment that can stop or slow down Dupuytren's disease in its early stage. In radiation therapy, the nodules and cords associated with Dupuytren's are irradiated from a distance of .5 - 1 cm either with X-Rays (e.g. 120 kV = soft X-Rays that do not penetrate deeply into the body) or with electrons (3 - 10 MeV). This is typically done over five days in a row applying an efficient dose (single dose 3 Gy, total dose 15 Gy). After a break of six weeks, this treatment is repeated. Typically this softens the nodules or cords and prevents contraction of the hand.

Setup for radiation therapy of Dupuytren's disease (Dupuytrens) with X-rays. The patient is shielded from radiation by the equipment itself, a lead mask between equipment the conus and the hand, the material under the hand, and the lead apron.

(Picture provided by Alfried-Krupp-Krankenaus, Essen, Germany)

 

Positive effects of radiation therapy

Radiotherapy is capable of stopping the growth of Dupuytren nodules or cords either permanently or for a long time. Occasionally, small nodules will even shrink or disappear. Radiotherapy cannot make an already bent hand straight again. Below is a graph from a presentation by Seegenschmiedt et al. at the ASSH meeting 2006 illustrating how radiation therapy delays disease progression and in favorable cases can render surgery unneccessary. Blue lines indicate the disease progression after radiotherapy, the dotted line indicates a potential healing effect in early stage treatment (for details please refer to the full presentation).

The effectiveness of radiotherapy depends on the stage of the disease. It is very promising in early stages where the nodules are relatively small. Research at the University of Erlangen, Germany, showed the following: ten years after the therapy, for 84 percent of the patients having Dupuytren in stage N (just nodules and cords) and 67 percent of stage N/I (hand bent by 1-5°), the disease either had not progressed or had actually improved (Adamietz et al., see below). The success rate becomes lower in later stages. Overall, radiation therapy seems to be able to stop or significantly slow down Dupuytren's disease in the early stage. If it doesn't, surgery or NA are still possible.

One of the difficulties of radiation treatment is that only a few people consult their doctor in the very early stage of Dupuytren's, when the nodules are only a few millimeters in diameter and when radiation treatment is most beneficial. Another problem is that radiotherapy as a means to cure Dupuytren's disease is not widely known, especially outside Germany and Austria.

 

Radiation therapy - how does it work?

Dupuytren's disease and Ledderhose disease start with fibrous tissue in form of nodules that, specifically in its initial stage, is biologically very active ("proliferative"). Like in wound healing this tissue maturates (building cords for Dupuytren's) and eventually contracts (actively or passively fixing a contraction). The initial proliferating stage is most suitable for radiotherapy. Radiotherapy seems to be able to affect the development of the involved fibroblast and myofibroblast cells (in other terms the involved growth factors) and reduce their growth rate. There is indication that this is achieved by affecting the development paths of the myofibroblast cells. As the growth of a nodule is the net effect of building new cells and of removing dead cells, the slowing down of the growth of new cells can result in shrinking and softening of the nodule. - While there is a variety of publications on the macroscopic results of radiotherapy of Dupuytren's, the understanding of the radiobiological proccesses is still a matter of basic research. For more details please refer to the literature (section 9.5.3.1. of "Radiotherapy for Non-Malignant Disorders" and the Degro 07 paper by Blaese and Rodemann).

 

Radiotherapy of Ledderhose disease

Above comments apply for Ledderhose accordingly. Because Ledderhose shows less cords but mostly larger nodules, radiation therapy is applied to those larger nodules as well. Below is an example of an x-ray treatment showing how lead shielding is applied for limiting the radiated area (shielding of electron beams is more difficult, therefore typically the whole area is radiated). Below pictures were provided by Dr. Herkströter of Städtische Kliniken Frankfurt.

Marking of nodule (center) and to be radiated area prior to treatment.

Protecting the surrounding area with a lead shield prior to x-ray treatment.

Treatment position. X-ray equipment applied.

(pictures provided by Städtische Kliniken Frankfurt/M.-Höchst)

Page last modified: 10/24/2008