Dupuytrens Radiation Questions with Prof Seegenschmiedt




There were a few questions which I had about the radiation treatment, some of which have also been raised by other members of the International Dupuytren Society forum. As I am a patient of Prof Seegenschmiedt, I thought I would ask him directly via email for clarification.

email date 11th July 2012.

Strahlenzentrum Hamburg

Does radiation therapy work better on nodules than it does cords?

Strahlenzentrum Hamburg

MHS: In my experience there is a trend but not a consistent answer; it appears that cords may contain more scar tissue than nodules, which make them more responsive to RT.

However, there is an important fact to consider, that is the consistency of the nodules and cords. For practical reasons (easy to explain to patients !) I am using the following scale:

TOMATO = grade 1
ORANGE = grade 2
TENNISBALL = grade 3
COCONUT = grade 4

The grade 1 and 2 consistencies being nodules or cords do respond much better with regard to remission; they may even disappear completely, while the grade 3 and 4 consistencies being mostly cords but may be also nodules do not respond well to RT and may even become more hard than before.

Strahlenzentrum Hamburg

What type of equipment is used at the Strahlenzentrum is it x-ray or e-beam? Does it make any difference if x-ray or e-beam is used?

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MHS: In my understanding Electron beams are more flexible to adapt to different depths which is especially important for Ledderhose Disease; however the set-up time on the machine is similiar, the radiation time is usually shorter with E-beam and with regard to the field edges the effect with E-beam is more precise.

Strahlenzentrum Hamburg

Is there a document on the internet which discusses whether e-beam is better than x-ray for Dupuytrens?

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MHS: No, not that I know ... It's just simple physics.

Strahlenzentrum Hamburg

What happens if the second treatment series is not done? The UK NICE guidance implies just one treatment series as standard:

TEXT FROM NICE GUIDANCE:
Radiation therapy is delivered to the nodules and cords that have formed in the hands and is given over several consecutive days, until the planned radiation dose (usually about 15 Gy in 5 fractions) has been delivered. In severe disease, particularly if there is contracture of the proximal interphalangeal joint, more than 1 course of treatment may be used, with each course being separated by a few weeks.

NICE Guidance Nov 2010 IPG368 Radiation therapy for early Dupuytren's disease

It seems that NICE have read studies based on 21Gy and 30Gy, but misinterpreted the radiation concept/protocol used in Germany which seems to be two series for all Dupuytrens cases.

Strahlenzentrum Hamburg

MHS: ONE series consists of phase ONE and phase TWO --> i.e. if you do only ONE phase you have only HALF the TREATMENT

There is only poor evidence for 10 x 2Gy in ONE SERIES ---> just one single study --> Koehler et al;

The best evidence is for 10 x 3Gy or 8 x 4Gy and also our own study with 7 x 3 Gy in ONE series.

As the FIBROBLASTS are the target cells a higher single dose per fraction appears more favourable.

The best results have been achieved with for 10 x 3Gy in TWO phases of 5 x 3Gy, but 3 months apart.

Strahlenzentrum Hamburg

In past literature and also on websites the interval between series is sometimes 6 weeks, sometimes 8 weeks, now it is 12 weeks. Is the conclusion now that a 12 week gap is better for treatment of Dupuytrens?

Strahlenzentrum Hamburg

MHS: I think it is a better schedule, as 6 weeks may be too early to assess the development and may have some reaction left behind.

I personally had the best experience with 12 weeks apart !

Strahlenzentrum Hamburg

To return back to Dupuytrens Radiation Treatment Report, Hamburg June 2012 click on:
Dupuytrens Radiation Treatment Report, Hamburg June 2012