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Feasibility of aponeurectomy in combination with perioperative 192Ir high dose rate brachytherapy for Dupuytren’s disease

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Abstract

Purpose

Partial aponeurectomy (PA) is a standard procedure for Dupuytren’s contracture (DC). Here we report a novel approach using surgery combined with perioperative high dose rate (192Ir-HDR) brachytherapy.

Methods and patients

From March 2018 until February 2020, thirteen rays of 6 patients with Dupyutren’s contractures underwent PA followed by HDR brachytherapy. After removal of fibrous tissue and mobilization of the tendons, one to three catheters per patient were placed intraoperatively. Immediately after surgery, a planning computer tomography with 3D-planning was performed. Then 10–12 Gy were given to 0–2 mm from the catheters’ surface and the catheters were removed 6–12 h after brachytherapy.

Results

No complications were observed. The mean contractures were reduced from 55.4° (standard error SE 19.6) to 15.4° (SE 6.7; p < 0.01). One patient showed progressive fibrosis of a nontreated ray during follow-up.

Conclusions

HDR brachytherapy in combination with surgery is feasible and harbors the potential for combined modality therapy to reduce relapse rates of advanced or relapsing DC. Controlled studies are warranted to investigate the role of bimodal therapy compared with PA alone.

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Authors and Affiliations

  1. Department of Radiotherapy and Radiation Oncology, Dessau City Hospital, Auenweg 38, 06347, Dessau, Germany

    I. Frank Ciernik M.D., Philipp Goldschmidt M.Sc. & Markus Wösle Ph.D.

  2. University of Zurich (MeF), Zürich, Switzerland

    I. Frank Ciernik M.D.

  3. Department of Plastic and Hand Surgery, Dessau City Hospital, Dessau, Germany

    Jochen Winter M.D.

Authors
  1. I. Frank Ciernik M.D.
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  2. Philipp Goldschmidt M.Sc.
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  3. Markus Wösle Ph.D.
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  4. Jochen Winter M.D.
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Corresponding author

Correspondence to I. Frank Ciernik M.D..

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Conflict of interest

I. F. Ciernik, P. Goldschmidt, M. Wösle and J. Winter declare that they have no competing interests.

Ethical standards

No objections were evoked by the ethical committee of Saxony-Anhalt, Germany and the internal review Board of the Städtische Klinikum Dessau, Germany to publish our experiences and the present case series. All patients were fully informed and provided written consent on the individual case-based treatment approach and the novelty of the individualized treatment to assess feasibility of a bimodal therapy combining mobilization and perioperative brachytherapy to minimize the risk of relapse of Dupuytren’s contractures.

Supplementary Information

66_2021_1801_MOESM1_ESM.docx

Studienprotokoll für die Evaluation des Stellenwertes der perioperativen Radiotherapie nach Aponeurektomie bei fortgeschrittenem M. Dupuytren

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Ciernik, I.F., Goldschmidt, P., Wösle, M. et al. Feasibility of aponeurectomy in combination with perioperative 192Ir high dose rate brachytherapy for Dupuytren’s disease. Strahlenther Onkol 197, 903–908 (2021). https://doi.org/10.1007/s00066-021-01801-5

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  • DOI: https://doi.org/10.1007/s00066-021-01801-5

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