Background
Prospective single-arm study. 72 patients with histologically confirmed early-stage Dupuytren's contracture (Dupuytren's disease, stages N1–N2 per Tubiana classification). Treated with RT to both palms using orthovoltage or electron beams. Aimed to assess efficacy of low-dose RT in preventing disease progression and inducing fibroblast quiescence in early symptomatic Dupuytren's.
Interventions and follow up
Arm A: 2 courses of RT (3 Gy/fraction × 5 fractions = 15 Gy per course), separated by 6–12 weeks; total dose 30 Gy; orthovoltage X-rays or 6 MeV electro
Primary endpoint: Disease stabilization (no progression of nodule or cord) at 1 and 5 year
mFollow up: 5.0 year
Primary endpoint: Disease stabilization (no progression of nodule or cord) at 1 and 5 year
mFollow up: 5.0 year
Results
Stabilization at 5 yr: 71% (no progression of contracture or nodule growth)
Partial regression: 15% (softening of nodules)
Progression requiring surgery: 14%
Patient satisfaction: 72% satisfied or very satisfied
Partial regression: 15% (softening of nodules)
Progression requiring surgery: 14%
Patient satisfaction: 72% satisfied or very satisfied
Adverse events
Main adverse events: Acute: erythema (grade 1–2) 30%, dry desquamation 8%, pruritis. Late: no significant fibrosis, telangiectasia, or secondary malignancy at 5-year follow-up. Skin atrophy: mild in 5%. No functional deficit from RT.
Conclusions
Low-dose RT (30 Gy in 2 courses) effectively stabilizes early Dupuytren's contracture in the majority of patients, preventing progression to more advanced contracture requiring surgery. RT is appropriate for stages N1–N2 with nodule or early cord formation.
Key Limitations
Key Limitations: No randomized comparator. Short-term follow-up (5 years) — late disease progression and RT late effects not fully characterized beyond this. Patient-reported outcomes not standardized. Selection for early-stage disease may introduce bias toward favorable natural history.
Clinical Context
RT for Dupuytren's contracture is an established non-surgical treatment for early-stage (N1–N2) disease. Current practice: 30 Gy in 2 series of 15 Gy (5 × 3 Gy) separated by 6–12 weeks using orthovoltage or electrons. Surgery (fasciectomy or collagenase injection) is reserved for stage III–IV contracture. RT should be offered before contracture requires surgery.
References