Radiotherapy Treatment

Treatment of Dupuytren’s Disease using Radiotherapy has been studied and described in the medical literature since the 80’s and is now an established method for treating early stage active Dupuytren’s and also Ledderhose. The treatment can stop or slow down Dupuytren’s disease in its early stage, best if the disease is active (growing) so it is sensitive to the radiation but before there is a contracture of more than 10 degrees.

In the UK the National Institute for Health and Clinical Excellence (NICE) has issued limited guidance to the NHS for Radiotherapy on early Dupuytren’s disease (2016). There are a few places where it is available on the NHS, and there are more clinics offering this treatment privately in England, see the map lower down on this page.

Radiation Therapy or Radiotherapy is a well established treatment for cancer, that uses ionizing radiation to damage the DNA in cancerous cells. It can also be used for the treatment of benign tumours, but this is not done as often since these tumours are not usually life threatening. For superficial conditions like Dupuytren’s the amount of radiation given is a lot lower than that for malignant conditions, which reduces the risk of side effects greatly.

With radiation therapy, the nodules and cords associated with Dupuytren’s are irradiated either with X-Rays or with electrons (see this blog for the difference). This is done over five days in a row applying a daily dose of 3Gy with penetration limited to a few mm only, making a total dose of 15Gy. (This is the ‘German or European protocol’). See also Dupuytren’s Radiotherapy.

After a break of typically eight to twelve weeks, the treatment is repeated. This is the most commonly used protocol, there are others in use, for instance treating seven days and no repeat. The disease needs to be symptomatic (active) at the time of treatment and often the result is a softening of nodules or cords, and a slow down or even complete halt in the disease progression. Beneficial results may take a few months to a year to become apparent.

About the different types of treatment:

X-rays, also called photons by the Radiation specialist, are used to treat Dupuytren’s and Ledderhose. These superficial x-rays are delivered by an Orthovoltage machine. Electron therapy uses electrons which are made by a much larger machine called a  Linear Accelerator.

Both X-rays and electrons are suitable for treating superficial tissue disease such as Dupuytren’s and Ledderhose nodules and deliver the same type of radiation to the diseased tissue in the hands or feet, with the same result and benefit. There is no difference in the long term benefit or response. Results are equally good.

Orthovoltage machines create X-rays that start working close to the machine, so the head of the machine will be close to the hand or foot. The X-ray beam from this machine is very precise but despite this we will ask you to wear a lead protective apron during treatment. Wax or gel packs are not needed. A suitable safety margin is commonly added around the treatment area to make sure there is no drop-off in strength where the radiation is needed. The orthovoltage machine is best used for treating Dupuytren’s and Ledderhose. Despite the fact that the superficial X-rays only enter 3-4 mm below the skin’s surface, they are very effective and give uniformly excellent results when used to treat these conditions.

Linear Accelerators produce high energy electrons (electrons are negatively charged particles that become superficial X-rays once the are through the skin in going into the tissue). This treatment becomes effective further away from the machine, and deposits electrons a bit deeper under the skin, so you may require a wax or gel pad to ensure they act like superficial X-rays. A lead apron is not required when this machine is used.

Electrons are used a lot for treating cancer patients. However some Centres use mainly the Linear Accelerator to produce electrons and also to treat Dupuytren’s or Ledderhose. This means you may have a longer wait for treatment because those having cancer treatment will be prioritised.

(With thanks to Dr J Glees for helping with the above description)

Potential short and long term side effects are discussed on the International Dupuytren’s Society site. Side effects are usually short term and may include tanning of the skin, dryness, redness and some soreness, similar to sunburn

All radiation carries some degree of risk to health, but in this case the risks are extremely low due to the low dose, penetration limited to just a few mm, the location of the target being an extremity of a hand or foot hence away from critical organs, and in the case of using electron beams the narrow field being localised to the treatment target with no scatter (no need to shield other parts of the body with lead).

One of the UK’s leading radiation oncologists had an independent audit done in 2016 of his  results of radiotherapy for early Dupuytren’s. The results of treating 150 patients were audited, no serious adverse reactions were noted and 91 percent of patients had the disease progression stopped or even improved with the treatment.  The poster presented at a large radiotherapy conference can be downloaded as pdf Early Dupuytrens RT audit poster Dr J Glees  or viewed here.

A short YouTube video explaining radiotherapy for Dupuytren’s Disease can be found here.

 

There is an excellent blog by one of the UK’s leading radiation oncologists who treats Dupuytren’s and Ledderhose about what to expect after radiotherapy for Dupuytren’s or Ledderhose.

A list of the clinics can  be found on our Doctors page.

 

 

Patient experience

Read here the story of the first patient to have radiotherapy on the NHS. An account of private treatment in the UK can be found here. More stories of different treatments can be found in the stories section.

A UK patient has provided a very good and informative page on radiotherapy in Germany.  This includes lots of useful tips on hotels and bus/train connections in the area, a flowchart on treatment choices, and a question and answer dialogue with Prof Heinrich Seegenschmiedt the pioneer of using radiotherapy for treating Dupuytren’s. It was written in 2012.

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