Review of Radiation Therapy for Palmar and Plantar Fibromatosis (Dupuytren and Ledderhose Disease)

Abstract

Palmar fibromatosis and plantar fibromatosis, called Dupuytren disease and Ledderhose disease (DD, LD), respectively, are chronic inflammatory and hyperproliferative connective tissue disorders which involve the palmar fascia of the hand and the plantar fascia of the foot, where they produce nodules, cords, and contractures; in addition, the overlaying subcutaneous fat and skin layers can be affected. These digitopalmar and digitoplantar alterations are part of a deforming and progressive, irreversible condition and part of a systemic connective tissue disorder (Enzinger and Weiss 1995), which is characterized by typical biochemical changes and additional fibrous deposits located at the dorsal PIP joint (forming knuckle pads), on the ear helix, the hand wrist, the elbow, and the penis forming a penile angulation (Peyronie disease). Although the tissue changes appear to have some pathohistological similarities, many studies and research efforts to identify a single cause of this generalized disorder have failed so far (Tomasek et al. 1999; Rudolph and Vande Berg 1991). Although numerous hypotheses exist about the disease onset and progression, the specific role of mesenchymal stem cells, fibroblasts, and myofibroblasts and the correlation with the clinical development of DD and LD are still not conclusively answered (Rödel and Seegenschmiedt 2016).