Background
Large prospective multicenter cohort study. 517 patients with various stages of Dupuytren's contracture treated with RT at 10 centers in Germany and Austria. Evaluated outcomes of RT across Tubiana stages N–N2, dose/fractionation patterns, and long-term disease-free survival and local control at 5 and 10 years. The largest prospective RT series for Dupuytren's disease. Seegenschmiedt MH et al, Strahlentherapie und Onkologie.
Interventions and follow up
Arm A: RT: 21 Gy (stage N) or 30 Gy (stages N1–N2) in 2 series of 10.5 or 15 Gy respectively (5 fractions of 2.1 or 3.0 Gy), separated by 6–12 week
Primary endpoint: Progression-free rate at 5 and 10 year
mFollow up: 10 year
Primary endpoint: Progression-free rate at 5 and 10 year
mFollow up: 10 year
Results
5-yr progression-free (all stages): 72%
10-yr progression-free: 55%
Best outcomes (stage N, 21 Gy): 5-yr PF 84%, 10-yr PF 72%
Surgery avoided at 10 yr: 67% of patients
10-yr progression-free: 55%
Best outcomes (stage N, 21 Gy): 5-yr PF 84%, 10-yr PF 72%
Surgery avoided at 10 yr: 67% of patients
Adverse events
Main adverse events: Acute: erythema grade 1–2 in 35%, dry desquamation 12%. Late (10 yr): skin telangiectasia 6%, skin fibrosis grade 1 in 4%, no secondary malignancies, no functional hand deficit attributable to RT. Patient satisfaction: 80% satisfied at 10 years.
Conclusions
RT provides durable long-term disease stabilization for early-stage Dupuytren's contracture with minimal late toxicity at 10 years. Optimal results in Tubiana stage N with 21 Gy; 30 Gy appropriate for N1–N2. Two-thirds of patients avoid surgery at 10 years following RT.
Key Limitations
Key Limitations: Observational, non-randomized. Long-term natural history of Dupuytren's disease varies widely, making it difficult to attribute stabilization entirely to RT vs natural disease plateau. Stage N may have lower spontaneous progression rate. Secondary malignancy follow-up is limited to 10 years in this cohort.
Clinical Context
This large German multicenter series provides the most comprehensive long-term data on RT for Dupuytren's. It informs current dose recommendations: 21 Gy/7 fractions (2 courses) for stage N; 30 Gy/10 fractions (2 courses of 15 Gy/5 fractions) for N1–N2. Repeat RT is feasible after 5 years if progression occurs.
References