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Coffee Talk – Q&A session


Dr Richard Shaffer was recently asked to host a Q&A session with members of the Dupuytren’s Disease Support Group (DDSG). The topic of the session was Radiotherapy for the treatment of Dupuytren’s, Ledderhose and Peyronie’s disease.

As lots of interesting questions were raised in the Q&A session, we wanted to share some of the highlights with you:

 

Q: We understand that early stage disease has best outcomes with radiotherapy. Have you treated patients who have had Dupuytren’s for many years, with no contracture?

A: Yes. I don’t feel that time in itself is an issue for treatment. The important thing in my view is that it has recently progressed, which effectively is used as a surrogate for being biologically active.

When I treat patients with disease on their hands, there are a few groups of patients:

  • One group is those who have early worsening disease that need radiotherapy to stop further worsening and to stop contracture.
  • The second group is those who have had some sort of release procedure (surgery, xiapex, needle) and radiotherapy is to prevent re-contracture.
  • The third group is those who have functional deficit or symptoms (e.g. pain), and radiotherapy can be effective in increasing function in this last group.

 

Q: Could products such as magnesium oil interfere with radiotherapy? How far in advance of radiotherapy do you have patients discontinue topical treatments for Dupuytren’s or Ledderhose? When can topicals be resumed after treatment with radiotherapy?

A: Good question. I tend to ask patients to stop supplements during the radiotherapy and for a couple of weeks after, if there is an effect (either positive or negative) then I’d rather it not interact with the treatment I give.

 

Q: Are some skin types more susceptible to radiation burns than others? DDSG has had a few members experience burning and peeling shortly after radiotherapy.

A: I have had a few patients who have had more skin toxicity than I expected from radiotherapy, but these seem to have been due to particular triggers. It is important to treat your hands well in the month after each week of treatment, so avoiding very heavy work/chemicals etc. But there’s no evidence that particular skin types are more susceptible.

 

Q: We have been told that there is not a single case of cancer from radiotherapy for DD/LD reported in the medical literature. How would such a case be reported? And where would it be discussed? Would the treating doctor write up a case report and publish it? What are the chances that there have been cases that never got reported?

A: Yes – excellent question. My feeling is that it is both over-emphasised (as it is a theoretical risk, and very low risk particularly in older patients), and under-reported. Under-reporting is due to all the factors that you mention, as patients may have either no follow-up or only short follow-up, and therefore this information is either lost or not ascribed to the radiotherapy. Realistically, it will be very difficult to get any direct information about this, which is why is remains so obscure in terms of quantifying it.

 

Q: In your experience, does radiotherapy worsen the symptoms of arthritis for patients who have that?

A: Not in my experience. In fact, radiotherapy used to be used in particularly resistant cases of rheumatoid arthritis to reduce the inflammation. It’s not used so much now as there are many more drugs available. It should not affect osteoarthritis.

 

We hope you find the above information interesting, you can join the DDSG forum on Facebook or visit their website for more information: www.dupuytrensdiseasesupportgroup.com

To book a consultation with Dr Shaffer or submit an enquiry you can contact us, call on 0808 1565 900 or email us directly.