Dupuytren treatment with radiation therapy for small hand nodules only

Dupuytren radiotherapy is the medical use of low-level x-ray radiation directed specifically at the involved hand lump and nodules, spread out over several sessions with a few month interval of non-treatment between each.   The effectiveness of Dupuytren radiation rests on its use as a preventative measure when used early in the disease process to prevent progression, not as an active treatment for later phase hand contracture.

Dupuytren radiotherapy is a fairly recent innovation for medical treatment of Dupuytren contracture before it evolves into finger contractures and limited hand usage; all other medical treatment is applied later in its progression.

According to the German medical clinics who are currently performing the bulk of these procedures, Dupuytren treatment with radiation therapy has a favorable outcome and is said to be able to stop the development of a tiny bump in palm either permanently or for a reasonable length of time; they report that occasionally the Dupuytren nodules disappear entirely if they are tiny when treated.  The significant drawback of Dupuytren radiotherapy is that once someone with Dupuytren contracture develops finger contracture or bending, this procedure is not able to produce any tissue changes.   It is not clear why clinics or universities in the U. S. are not performing Dupuytren radiotherapy.

Radiotherapy for Dupuytren contracture

Generally, radiation therapy (RT) is that branch of medical practice concerned with cancer treatment by means of high-energy beams of ionizing radiation directed at the intended diseased target tissue.  RT functions to server to control cancerous tumor growth while limiting and minimizing radiation exposure to the adjacent normal and healthy tissue.

The most common technique of radiation therapy for Dupuytren contracture is to deliver one radiotherapy series of five sessions performed five days in a row, in which five GY of radiation are delivered, followed by a pause in therapy that could be anywhere from six to 12 weeks, after which another radiotherapy series of five sessions performed five days in a row, in which five GY of radiation are again delivered.  Some medical clinics deliver 3 GY or 4 GY daily for a five day total series dose of 15 GY or 20 GY.

A GY (gray unit) is the international system (SI) unit of an ionizing radiation dose expressed in terms of absorbed energy per unit mass of tissue.   A gray (GY) is the unit that expresses the absorbed dose of radiation.  The GY has replaced the older term, rad. Now, one GY equals to one Joule/kilogram and also equals 100 rad.

Radiation therapists who perform this treatment justify its use in Dupuytren contracture explaining that radiation damages a special soft tissue cell, the fibroblast, which is an important cellular component for the progression of the disease.  Yet, this same group of doctors admits that it is very difficult to find scientific evidence to prove that radiation selectively destroys or alters fibroblasts.  They also admit radiation therapy is unproven for Dupuytren contracture since it is impossible to collect verifiable data about their controversial therapy because hand  nodules and cords are known to be dormant or stagnate for months or years at any time during the course of the disease, with or without Dupuytren treatment.

Interestingly, it is in the guidelines of the German Association for Hand Surgery (Germany is where most Dupuytren radiotherapy is performed) that call this use of RT in Dupuytren treatment as  obsolete and out of use.  Among the reasons for their position is the potential for negative unintended consequences of radiation therapy:

• Radiation burn injury to the skin
• Cumulative radiation exposure from and/or treatment either before or after Dupuytren RT may cause cancer
• Unknown consequences of this procedure, such as interference with later surgery of the hand due to tissue weakness created by the RT for those who do not respond favorably
• Very few clinics or facilities that perform this procedure have sufficient experience and knowledge or correct equipment, to perform Dupuytren radiotherapy –yet do so.

As a result of RT exposure those who conduct this procedure report a typical softening of the nodules or cords so treated that prevents later contraction of the hand.

A significant difficulty of Dupuytren radiotherapy is that few people consult a doctor in the very early stage of Dupuytrens when this method of treatment is primarily beneficial.  Dupuytren RT is not used after the hand nodules are larger than a few millimeters across.

If your Dupuytren contracture is advanced beyond the early stages, or you are not interested in using ionizing radiation as a treatment option, consider Alternative Medicine to reduce the density and contraction of your Dupuytren hand problem.