Radiotherapy for Ledderhose disease
Although NICE provides guidance on using Radiotherapy for treating Dupuytren’s on the NHS, it is not mentioned for similar conditions such as Ledderhose or Plantar Fibromatosis. There are centres in the UK that treat Ledderhose with radiotherapy, both on the NHS or private. A list of the clinics can be found on our Doctors page.
It is not fully understood how radiotherapy helps, but it works best when performed on nodules that are considered active i.e. growing. When cells are in their active phase they are most sensitive to radiation. Radiation affects the development of the cells and slows their growth and therefore slows progression in Dupuytren’s and Ledderhose. This is because the overall growth of nodules is dependent on cell growth being faster than cell death.
Radiotherapy can be carried out on its own or after surgery to reduce the chance of recurrence. A typical protocol is daily treatment for 5 days, then a 6-12 weeks break, then another week treatment. Less common but also regularly used is the protocol of daily treatments for 7 days.
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 more useful when treating cancer patients. However some Centres use the Linear Accelerator to produce electrons for cancer patients and 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)
Acute (short-term) after-effects develop in roughly 25% of patients and typically include minor problems such as dry skin and a sunburn-like tanning of the skin. There is a possible longer term risk of cancer in the area as with all forms of radiotherapy, but the risks are minimal with the low dosages, minimal depth, and location away from vital organs.
In the book published in 2012 “Dupuytren’s Disease and Related Hyperproliferative Disorders” some results from treatment of Ledderhose with radiotherapy are discussed. Overall they saw that in the patients that had RT, 44% had a reduced number and/or size in nodules, however 90% of patients reported that they had an improvement with regards to symptoms, and only 7% showed progression. 83% of people who had pain on walking, and 68% of those who had pain at rest, said they had an improvement.
The chapter in the book concludes by saying that “Radiation Therapy is the most effective treatment for primary and recurrent Ledderhose Disease, due to very low progression or relapse rates.”
Radiotherapy is potentially a promising way of treating Ledderhose, as in most cases it shrinks the lumps although they don’t disappear completely, and pain is reduced. More research needs to be done to be able to give an estimate on how long the effect lasts, and whether the condition may recur or reactivate as is frequently seen after surgery.
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.
We have a special YouTube channel for our webinars and videos. Here specialists explain more about the different treatment options and the rationale behind them, as well as what might be possible in the future. The channel can be found here:
The webinars we have done are:
1/ Dupuytren’s disease and surgical treatments
2/ Percutaneous needle fasciotomy for Dupuytren’s
3/ Dupuytren’s Research updates
4/ Ledderhose Disease
5/ Radiotherapy for Dupuytren and Ledderhose
A website about radiotherapy, how it works, what different types there are and what the effects and side effects might be.
A blog and link to a book chapter on radiotherapy in Dupuytren’s and Ledderhose written by one of Britains leading radiation oncologists in the field.
A patients story of radiotherapy for Ledderhose can be found on this page.
Where is the treatment available in the UK? Go to our doctors and clinics page to see a list.