Radiotherapy for Dupuytren's

Radiation treatment for Dupuytren's disease has been performed since the advent of therapeutic radiation treatment. The effectiveness of radiation is reported as a preventative measure for early disease to prevent progression, not as a treatment for contracture. Although not widely embraced in the United States, there is a large European experience with radiotherapy of Dupuytren's Disease. Literature access is restricted by the unfortunate fact that reports have been published in journals whose publishers continue to lag behind the trend to provide open internet access access to their publications. Medline abstracts are available and a Medline search this month of Radiotherapy for Dupuytren's is available here (full text: http://www.dupuytrenfoundation.org/DupPDFs/2010_Medline_XRT.pdf). These articles report a benefit of radiotherapy in early stage Dupuytren's in slowing the progress of contracture, a low complication rate, no reports of radiation induced cancer and no interference with later surgery for those who failed radiation and developed progressive contractures. These reports must be reviewed with the knowledge of anecdotal reports in surgical texts of significant complications from radiation for Dupuytren's. The truth lies somewhere in between. The difficulty with interpreting reports of any treatment of Dupuytren's is lack of information regarding additional risk factors: The biologic aggressiveness of Dupuytren's, progression and recurrence, is predictably and significantly affected by family history, presence of knuckle pads, Ledderhose, Peyronie's or frozen shoulder, age, age of onset, bilaterality and number of digits involved, nodularity of disease, skin involvement, certain medications, alcohol intake and other risk factors. The true effectiveness of any preventative treatment must take these types of factors into account to have real validity. This is why a standard approach to documentation and a global collaborative effort to generate and analyze large amounts of data is important to make progress in developing better treatment options for Dupuytren's and related conditions.

Dupuytren's Diathesis

What is Dupuytren's Diathesis? Diathesis is a medical term meaning tendency toward a condition. One way of describing a person with Dupuytren's diathesis is that they have more of whatever Dupuytren's is. Diathesis usually means more aggressive Dupuytren's: earlier age of onset; more fingers involved; more often bilateral; faster progression; more recurrence problems. The hallmark is developing more than one member of the Dupuytren family: Dupuytren's; knuckle pads; Ledderhose; Peyronie's; frozen shoulder. More conditions means more aggressive biology. People with Dupuytren's diathesis are more likely to have ancestors with Dupuytren's and are more likely to pass Dupuytren's on to their children than people with only Dupuytren's. In this article, "Dupuytren's Diathesis: A Case Report" (full text: http://www.dupuytrenfoundation.org/DupPDFs/1964_Lettin.pdf), the difficulties experienced by a patient with Dupuytren's diathesis are described, as well as complcations from both surgery and radiation treatment. Diathesis is a persistent reminder that Dupuytren's is a systemic disorder which has many forms, and that we need to continue work to find a biological cure.