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Dupuytrens Radiotherapy: An Effective Treatment for Dupuytren's Contracture

Dupuytren's Contracture: Definition and Introduction

Dupuytren's contracture is a deformity of the hand that typically develops gradually, over a long span of time, even decades. Dupuytren's contracture distresses the connective tissue under the skin of the palm. Lumps of tissue form beneath the skin which eventually would form a dense cord that can pull one or more of a person's fingers into a bent position. Once the fingers are affected by Dupuytren's contracture, they can no longer be straightened completely, which can make difficulties in everyday activities. Examples of such tasks that are made complicated by this disease are, placing hands in pockets, shaking hands, or putting on gloves. Dupuytren's contracture commonly affects the ring finger and the pinkie or small finger, and it occurs most often in elder men of Northern European ancestry. A number of treatments are offered to slow the advancement of Dupuytren's contracture and to relieve its symptoms.

A Glimpse of Dupuytrens Radiotherapy

One of the most trusted methods for treatment is the Dupytrens radiotherapy. Also known as Radiation therapy, it is a non-invasive cure that can stop or slow down the progression of Dupuytren's disease especially in its early stage. In Dupuytrens radiotherapy, the nodules and cords connected with Dupuytren's are irradiated from a distance of .5 to 1 cm, either with X-Rays (soft X-Rays that do not penetrate into the body) or with electrons. This is normally complete over five days after applying an efficient dose. Subsequently after a six weeks, the Dupuytrens radiotherapy is repeated. Characteristically this relaxes the nodules or cords of the hand and prevents the tightening of the hand. Recently, a study has showed that a total dosage of 20 Gy has almost an identical effect which raises optimism of future experiments that further reductions of the over-all dose might demonstrate efficiency as well.

Positive Effects of Dupuytrens Radiotherapy

Radiation therapy is capable of discontinuing the advancement of Dupuytren nodules or cords either permanently or for a long period of time. Sometimes, minor nodules will even shrink or vanish. However, radiotherapy cannot straighten an already bent hand to its former normalcy.

The efficacy of Dupuytrens radiotherapy can vary on the stage of the disease. There is a greater curability in premature stages where the nodules are somewhat smaller. Based on a research done at the University of Erlangen in Germany, ten years after the therapy, for 84% of the patients having Dupuytren in the first stage affecting just nodules and cords, and 67% of the second stage wherein the hand is bent by 1-5°, the disease either had not progressed or had actually improved. The rate of success declines in advanced stages. Generally, Dupuytrens radiotherapy appears to be an efficient method of stopping or significantly slowing down Dupuytren's disease in the early stage. If radiation therapy is no longer effective, a patient can still resort to surgery.

One of the impediments of radiation treatment is that only a a small number of people check with their medical practitioner in the very early stage of Dupuytren's contracture, when the nodules are still a few millimeters in circumference and when radiation treatment is most favorable. Another challenge is that radiotherapy as a methpd to cure Dupuytren's disease is not widely acknowledged, especially outside of Germany and Austria.

Radiation therapy - How it works

Dupuytren's start with a fibrous tissue in the form of nodules that explicitly becomes proliferative in its early stage. Like in wound restoration, this tissue maturates and builds cords and eventually contracts. This initial flourishing stage is the most appropriate time to proceed to radiotherapy. Dupuytrens radiotherapy is able to affect the expansion of the involved fibroblast and myofibroblast cells whih are largely involved inits growth and contributes with the reduction the growth rate. There is an indication that this is completed by affecting the progression paths of the myofibroblast cells. As the development of a nodule is the aftermath of the construction of new cells and the removal of dead cells, the degeneration of the growth of new cells can cause shrinkage and softening of a nodule. There various publications on the macroscopic results of radiotherapy of Dupuytren's and the outcome of the radiobiological progressions are still undergoing further research.

Potential side effects of Dupuytrens Radiotherapy

As expected, a procedure that extinguishes or alters Dupuytren cells also has effects on other surrounding cells. A classic side effect is that the irradiated skin dries in a way. Aside from this and as far as we know, there are no further disadvantages and side effects. Radiotherapy does not cause any pain, though it seems to be a permanent effect. Nonetheless, it still makes sense not to radiate the whole hand but only the part where Dupuytren's has afflicted plus the immediate area around it. The rest of the hand should be covered with a lead screen. Also for protection reasons, the rest of the body should also be covered against radiation.

There are some questions though regarding the general concern about cancer resulting from high dose x-ray treatments involved in this procedure. Ultimately, the risk depends on the dosage and the energy of the x-rays and on the radiated parts of the body. There has been statements that for Dupuytrens radiotherapy, the increased possibility of obtaining cancer is negligible and there are no records of any patients who have developed cancer in irradiated areas. Based on the results of multiple studies, it is believed that the add-on risk for a lethal cancer is very low, and not even quantifiable. Perceptibly this is not a definite proof and thus cannot assess each individual case. Therefore patients essentially have to make a decision for themselves with the help of the guidance and consultation of their doctors as to whether they are willing to take that risk. In most medical societies and groups, Dupuytrens radiotherapy is considered a very effective, if not the only, means to completely stop Dupuytren in its early stages and to possibly avoid eventual surgery.

There is indeed a lot of hope for the treatment of Dupuytrens Contracture especially with the Dupuytrens radiotherapy method of treatment. Consult your general practitioner for more information and for referrals to specialists in your area today.