Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany.
Strahlenklinik, Universitätsklinikum Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany.
Strahlenther Onkol. 2010 Feb;186(2):82-90. doi: 10.1007/s00066-010-2063-z. Epub 2010 Jan 28.
In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis.
Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response.
According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy.
After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a "salvage" operation is still feasible.
在早期的杜普伊特伦挛缩症中，放射治疗用于预防疾病进展。本研究通过回顾性分析，评估了这种治疗的长期结果和迟发性毒性。
1982 年 12 月至 2006 年 2 月，135 例（208 只手）接受了正交射线（120 kV；20 mA；4-mm Al 滤波器）放射治疗，2 个疗程，5 次/天，每次 3.0 Gy，总剂量 30 Gy；间隔 6-8 周。根据 Tubiana 等人改良的分类法描述疾病的严重程度。2008 年 2 月至 2008 年 5 月间对最后一次随访结果进行了分析，中位随访时间为 13 年（范围 2-25 年）。评估了迟发性治疗毒性以及症状客观缓解情况，如分期和结节与索带数量的变化，并将其作为评估治疗效果的证据。
根据各期情况，123 例（59%）病情稳定，20 例（10%）改善，65 例（31%）进展。在 N 期，87%和 N/I 期 70%的患者病情稳定或甚至消退。在更晚期的阶段，疾病进展的发生率增加到 62%（I 期）或 86%（II 期）。66%的患者症状长期缓解（即烧灼感、瘙痒、压痛和紧张感）。在疾病进展的情况下，放射治疗并没有增加手术的并发症发生率，只有 32%的患者出现轻微的迟发性毒性（皮肤萎缩、干燥脱皮）。没有证据表明放射治疗会引起第二恶性肿瘤。
平均随访 13 年后，放射治疗对早期杜普伊特伦挛缩症（N 期、N/I 期）的疾病进展有预防作用，并改善了患者的症状。在放射治疗后疾病进展的情况下，仍然可以进行“挽救”手术。
