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Outcomes of Radiotherapy for Ledderhose Disease


Ledderhose Disease Radiotherapy Treatment

I thought it would be useful to look at the results of radiotherapy for Ledderhose disease patients. I treated my first Ledderhose patient in May 2011, since then I have treated 46 patients, a total of 60 feet, which means that I have treated both feet in 14 patients.

I have assessed all of my Dupuytren’s and Ledderhose patients with questionnaires at three months after the end of treatment, then a year after treatment, and then yearly from then.

Of course, this method has limitations: not all patients return the questionnaires, and not all patients answer the questions in sufficient detail to draw definitive conclusions.

Also, the ideal way would be to see the patients and to examine them as well as discuss the outcome in detail, but this is often not possible as my patients come for treatment from all over the UK (and sometimes from outside the UK) for treatment.

The questionnaire is split into several sections, which I’ll summarise here:

  • Side-effects – various questions about which side-effects (if any) are still present, their severity, and any treatment that is being applied
  • The disease – how are the nodules/cords, how are the symptoms associated with the disease, are you able to do more or less than before the treatment
  • The treatment – any comments (good or bad) about the treatment – only on the 3 month questionnaire

Results of Radiotherapy for Ledderhose Disease

Overall numbers

Of the 46 patients that I’ve treated with Ledderhose disease, 15 patients have (so far) returned their 1 year follow-up questionnaires. Of those 15 patients, 5 had both feet treated (i.e. a total of 20 feet), and 6 of them also had at least one hand treated.

Disease status

Radiotherapy improved 73% of patients’ nodules and cords, with a further 20% of patients noticing stabilisation of the nodules, giving a total of 93% of patients that have either improved or had disease stabilisation, with only 7% of patients noticing further worsening of their disease.

Disease change post treatment

Pain

Thirteen of the fifteen patients had pain associated with the nodules before the start of radiotherapy. Of those thirteen with pain:

  • In nine (69%) the pain was reduced after radiotherapy
  • In three (23%) the pain remained stable i.e. was no worse after radiotherapy
  • In one (8%) the patient had worse pain after radiotherapy

Pain after treatment

Function

Particularly encouraging was the fact that 10 of the 15 patients (67%) could do more with their feet i.e. could walk or run better due to a reduction in the pain and/or size of the nodules.

Five of the 15 patients (33%) could do just as much as before the treatment, with no worsening of the disease. None of the patients described worse function a year after the radiotherapy.

Functionality

Side-effects

Four of the 15 patients (27%) had some dryness at one year, but nothing worse.

Type of side effect at 1 year

Comparison with published results

Comparing results with other studies is difficult as the groups treated are not comparable, the outcomes are assessed in different ways, and the follow-up time is different.

But the table below illustrates that my results seem comparable with (and perhaps in some aspects better than) the results from the largest published study, which was presented and published by Seegenschmiedt and his group in Germany.

Dr Shaffer results vs Seegenschmiedt results

Overall, you can see that my results are very similar to their results from radiotherapy. Clearly, there are limitations to the comparison, as I’ve had to simplify the results from the German study, as they went into greater detail, for instance separating pain on walking and pain on standing.

Overall, I’m very pleased that I am able to give the same reduction in pain and increase in function as the best published results using radiotherapy for Ledderhose disease, and perhaps a better regression rate, which is quite a relief to me as well as to my patients.