How does radiotherapy work?
Low-dose radiotherapy can provide pain relief and prevent the progression of Dupuytren’s contracture. During your treatment, radiation is aimed towards the nodules to soften and shrink the lumps and prevent the formation of contractures. Radiotherapy reduces the growth of nodules and cords under the skin by altering the development and growth rate of fibroblasts, the cells which are responsible for creating the lumps in the connective tissue. Radiotherapy has an anti-inflammatory effect and reduces inflammation around the cords and nodules, reducing pain in the area.
Who is radiotherapy suitable for?
We find radiotherapy is best at treating the early stages of progressive Dupuytren’s contracture – when there is minimal to no bending of your fingers and it has worsened over the last 12 months. This is in line with recommendations by The Royal College of Radiologists¹ stating that radiotherapy is effective in the early stage of Dupuytren’s contracture when there is a minor contracture of up to 10 degrees.
If your contracture is at an angle greater than 10 degrees, radiotherapy is less likely to be the best treatment for you and your doctor may recommend alternative options.
The Dupuytren’s Practice is one of the UK’s leading specialist centres for radiotherapy treatment with extensive experience in Dupuytren’s contracture and other benign diseases. We’ll advise you whether this treatment is likely to be effective for you depending on your stage of the disease.
Effectiveness of radiotherapy for Dupuytren’s contracture
A long-term follow-up of a study looked at the outcomes of patients who had received radiotherapy for progressive Dupuytren’s contracture and compared it with patients who chose to be observed rather than treated.² Significant reduction in disease progression and the need for surgery was found in the patients who received radiotherapy compared to the group who did not. Overall, patients who received radiotherapy for the treatment of Dupuytren’s contracture were more than three times less likely to see their condition progress or need surgery to release a contracture, when compared to those that chose to only have their condition observed. Results from the study can be seen in the table below.
The outcome of 8-year follow-up after radiotherapy for Dupuytren’s contracture:
|Patient Treatment||Improvement or no change in disease (%)||Worsening of disease (%)||Needed surgery for a contracture (%)|
¹ Source: The Royal College of Radiologists. A review of the use of radiotherapy in the UK for the treatment of benign clinical conditions and benign tumours. 2015. Retrieved from www.rcr.ac.uk Accessed: March 2020
² Seegenschmiedt, MH., Keilholz, L., Wielputz, M., Hanslian, E., Fehlauer, F., Long-term outcome of radiotherapy for early-stage Dupuytren’s disease: A phase III clinical study. In: Eaton, C., Seegenschmiedt, MH., Bayat, A., Gabbiani, G., Werker, P., Wach, W. (eds). Dupuytren’s disease and related hyperproliferative disorders. New York: Springer, 2012.
What to expect from The Dupuytren’s Practice
Dr Shaffer is a leading expert in the use of radiotherapy to treat benign conditions. You can arrange an initial consultation to find out if radiotherapy could be an appropriate treatment for you.
During the consultation:
- Your consultant will ask questions, perform an examination and discuss treatment options with you, including benefits and possible side effects
- If it’s agreed that radiotherapy is right for your condition, you’ll need to sign a consent form for your treatment
- Your consultant will then outline the nodules and cords which are to be treated
- A safety margin will be marked around the tissue to be treated – this allows us to treat the affected area while protecting the unaffected part of your hand
- A radiographer will then take a photograph of the area and make a tracing so that the area can accurately be treated each day
- After this has been done, you can go home – your treatment will generally start at least a few days later
During your radiotherapy treatment:
- You’ll be asked to position yourself underneath a radiotherapy machine, with the hand placed on a positioning bag for the duration of your treatment
- Each appointment will take around 10 minutes each day, with the radiotherapy treatment itself taking just under a minute to complete
Your radiotherapy for Dupuytren’s disease will be administered over five consecutive days (excluding weekends) and then repeated after a three-month break.
The radiotherapy will be targeted to the same area throughout your course of treatment, even if the nodules in the hand seem to be decreasing in size. This is done in order to limit the likelihood of recurrence after treatment.
After your radiotherapy treatment:
You’ll receive a follow-up call from us to check how you’re doing after your treatment – here you can discuss any problems, side effects or questions you may have.
Three months after your treatment, you’ll be sent a questionnaire by your consultant so we can assess how your hands are. If necessary, you’ll be able to have an additional consultation over the phone or at one of our clinics to discuss your outcomes in more detail.
Risks of radiotherapy treatment
You may experience some minor side effects when having your radiotherapy treatment. Your personal risk will be discussed with you during your initial consultation with The Dupuytren’s Practice team.
During your radiotherapy treatment, you should not experience any side effects – it doesn’t make you feel drowsy or dizzy and it does not cause pain.
Short-term side effects
Two to three weeks after the end your radiotherapy course, the skin on your palm may become a little red, sore or dry – this tends to be very minor (although about 1 in 100 people can get swelling or weeping around the area).
Most people find putting some moisturiser on the area is enough to treat the dryness.
Long-term side effects
Around one in five people find that the dryness continues.
Some people notice minor changes in the skin, such as it being thicker, thinner, rougher, or smoother than before the treatment.
While there is a theoretical risk of developing a cancer in the skin around the treated area, the risk is very small – in the region of 0.01% to 0.1% (between 1 in 10,000 patients and 1 in 1,000 patients). The radiation is precisely targeted at the lumps to avoid unnecessary exposure to other areas of your hand or foot. It’s also important to note that the radiation dose is much lower than radiotherapy treatment for cancer. If you have any concerns during your treatment, your radiographer will be available to answer your questions at any time.
Dose of radiation
The dose of radiation that is received for the treatment of benign conditions is considerably lower than the dose given for cancer. Cancer patients are usually treated with radiation levels between 50 to 70 Gy. However, the total dose you’ll receive for your Dupuytren’s disease in total across the ten days is 30 Gy.