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Long-Term Outcome of Radiotherapy for Primary and Recurrent Ledderhose Disease

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Dupuytren’s Disease and Related Hyperproliferative Disorders

Abstract

Purpose: Use of radiotherapy (RT) for treating primary and recurrent plantar fibromatosis (Ledderhose disease, LD) has been reported in a few clinical studies. This chapter presents and analyzes for the first time the results of a long-term study. Initial results of our pilot study on a smaller number of patients with shorter follow-up have already been published (Seegenschmiedt 2007; Seegenschmiedt and Attassi 2003). Patients & Methods: From 01/1997 to 12/2009, 158 consecutive patients (91 males, 67 females; mean age 49, median 52, range 9–81 years) were referred for treatment. Ninety-four feet were unaffected and 222 feet affected (84 bilateral, 29 right, 25 left). Ninety-one patients (47 males, 44 females) received RT on 136 feet; 67 patients with 134 feet served as control w/o RT: prior to first contact all patients had growth or an increasing number of nodules (N) and cords (C); moreover, 88 (97%) had symptoms (S) within 6–12 months including pain (P), numbness (N), or other symptoms (O); 86 (95%) had walking difficulties (W) due to pain and/or used orthotics. Thirty-five feet (26%) had recurrent or progressive LD after one or more surgical procedures before RT. Orthovoltage RT (125–150 kV X-rays) was used in all cases with the exception of two adolescents (3 feet) who had megavolt electron beam RT due to more complex target volumes. RT was applied in 5 weekly fractions of 3 Gy repeated after a mean of 12 (range 10–15) weeks up to 30 Gy total dose; three patients (5 feet) received only one RT series. Primary endpoints were (a) prevention of progression (PP) and avoidance of surgery (AS). Secondary endpoints were number or size of nodules or cords, symptom relief including pain relief, function, subjective satisfaction using a linear analogue scale (LAS), and radiogenic side effects scored according to the Common Toxicity Criteria (CTC) and Late Effects Normal Tissue (LENT) scales. Results: In 01/2011, all patients (feet) with a minimum follow-up (FU) of 24 months were evaluated; mean FU was 68 (range 24–144) months. Six (7%) patients (11 (8%) feet) had progression and of those 5 (6%) patients (7 (5%) feet) had salvage surgery, one with longer healing period. Sixty feet (44%) remained stable and 65 (48%) feet regressed with regard to nodules, cords, or symptoms; of those, 35 feet achieved complete remission (CR) with freedom of all nodules, cords, and symptoms; 30 feet had partial remission (PR). Previous symptoms and dysfunction improved in up to 90% of all sites. Patients’ satisfaction improved by 3.2 points on the subjective symptom score in 81 (89%) patients. Acute side effects (CTC 1° or 2°) occurred in 29 (21%) or 7 (5%) feet. Chronic sequelae (LENT 1°: dryness or fibrosis of skin) occurred in 22 (16%) feet. No grade 3 acute or late side effects occurred. The control group without RT had significantly higher progression and surgical intervention rates. Multivariate analysis found recurrent LD, nicotine abuse, advanced and symptomatic disease as poor prognostic parameters. Conclusions: External beam RT is the most effective treatment both for primary and recurrent LD as compared to all published surgical results. After long-term follow-up (FU) of at least 2 years, only 6 (7%) patients (with 11 (8%) feet) had recurrent or progressive disease with only 5 (6%) patients (7 (5%) feet) requiring salvage surgery. As compared to the known outcome after surgery, RT reaches a high and long-term remission rate, causes much less side effects, is less impaired by relapses, and thus is highly cost-effective in the long-term management of LD. Although so far no cure is available for LD, the application of RT appears to be “best care” for primary early stage LD, while the potential role of RT for recurrent or progressive LD after completion of surgery has still to be defined in conjunction with foot surgeons in future prospective clinical trials.

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References

  • Adamietz B, Keilholz L, Grünert J et al (2001) Radiotherapy in early stage Dupuytren’s contracture. Strahlenther Onkol 177:604–610

    Article  PubMed  CAS  Google Scholar 

  • Allen RA, Woolner LB, Ghormley RK (1955) Soft tissue tumors of the sole with special reference to plantar fibromatosis. J Bone Joint Surg [Am] 37A:14–26

    Google Scholar 

  • Alusio FV, Mair SD, Hall RL (1996) Plantar fibromatosis: treatment of primary and recurrent lesions and factors associated with recurrence. Foot Ankle Int 17:672–678

    Google Scholar 

  • Aviles E, Arlen M, Miller T (1971) Plantar fibromatosis. Surgery 69:117–120

    PubMed  CAS  Google Scholar 

  • Beatty SR (1938) Roentgen therapy of Dupuytren’s contracture. Radiology 30:610–612

    Google Scholar 

  • Beckmann KT, Baer W et al (2004) Plantarfibromatose: Therapie mit totaler Plantarfasziektomie. Zentralbl Chir 129:53–57

    PubMed  CAS  Google Scholar 

  • Betz N, Ott OJ, Adamietz B, Sauer R, Fietkau R, Keilholz L (2010) Radiotherapy in early-stage Dupuytren’s contracture. Long-term results after 13 years. Strahlenther Onkol 186(2):82–90

    Article  PubMed  Google Scholar 

  • Cavolo DJ, Sherwood GF (1982) Dupuytren’s disease of the plantar fascia. J Foot Surg 21:610–612

    Google Scholar 

  • Classen DA, Hurst LN (1992) Plantar fibromatosis and bilateral flexion contractures: a review of the literature. Ann Plast Surg 28:475–478

    Article  PubMed  CAS  Google Scholar 

  • de Bree E, Zoetmulder FA, Keus RB, Peterse HL, van Coevorden F (2004) Incidence and treatment of recurrent plantar fibromatosis by surgery and postoperative radiotherapy. Am J Surg 187(1):33–38

    Article  PubMed  Google Scholar 

  • Delgadillo LA, Arenson DJ (1985) Plantar fibromatosis: surgical considerations with case histories. J Foot Surg 24:258–265

    PubMed  CAS  Google Scholar 

  • Dürr HR, Krödel A, Troullier H et al (1999) Fibromatosis of the plantar fascia: diagnosis and indications for surgical treatment. Foot Ankle Int 20:13–17

    PubMed  Google Scholar 

  • El Majdoub F, Brunn A, Berthold F et al (2009) Stereotactic interstitial radiosurgery for intracranial Rosai-Dorfman disease. A novel therapeutic approach. Strahlenther Onkol 185:109–112

    Article  PubMed  Google Scholar 

  • Fetsch JF, Laskin WB, Miettinen M (2005) Palmar-plantar fibromatosis in children and preadolescents: a clinicopathologic study of 56 cases with newly recognized demogra­phics and extended follow-up. Am J Surg Pathol 29:1095–1105

    PubMed  Google Scholar 

  • Godette GA, O’Sullivan M, Menelaus MB (1997) Plantar fibromatosis of the heel in children: a report of 14 cases. J Pediatr Orthop 17:16–17

    Article  PubMed  CAS  Google Scholar 

  • Haedicke GJ, Sturim HS (1989) Plantar fibromatosis: an isolated disease. Plast Reconstr Surg 83:296–300

    Article  PubMed  CAS  Google Scholar 

  • Herbst M, Regler G (1986) Dupuytrensche Kontraktur. Radiotherapie der Frühstadien. Strahlenther 161:143–147

    Google Scholar 

  • Herovici C (1961) Picropolchorme. Histoligical technic for the study of supporting tissue. Pathol Biol (Paris) 9:387–388

    CAS  Google Scholar 

  • Heyd R, Tselis N, Ackermann H et al (2007) Radiation therapy for painful heel spurs. Results of a prospective randomized study. Strahlenther Onkol 183:1–7

    Article  Google Scholar 

  • Heyd R, Buhleier T, Zamboglou N (2009) Radiation therapy for prevention of heterotopic ossification about the elbow. Strahlenther Onkol 185:506–511

    Article  PubMed  Google Scholar 

  • Heyd R, Dorn AP, Herkströter M, Rödel C, Müller-Schimpfle M, Fraunholz I (2010) Bestrahlung in frühen Stadien des Morbus Ledderhose [Radiation therapy for early stages of morbus Ledderhose]. Strahlenther Onkol 186:24–29

    Article  PubMed  Google Scholar 

  • Jansen JT, Broerse JJ, Zoetelief J, Klein C, Seegenschmiedt HM (2005) Estimation of the carcinogenic risk of radiotherapy of benign diseases from shoulder to heel. Radiother Oncol 76(3):270–277

    Article  PubMed  Google Scholar 

  • Janssen S, Johann H, Karstens H (2009) Endokrine Orbitopathie – Wie effektiv ist die Strahlentherapie? Strahlenther Onkol 185:61–62

    Google Scholar 

  • Johnston RE, Collis S, Peckham NH et al (1992) Plantar fibromatosis: literature review and unique case report. J Foot Surg 31:400–406

    PubMed  CAS  Google Scholar 

  • Kashuk KB, Pasternack WA (1981) Aggressive infiltrating plantar fibromatosis. J Am Podiatry Assoc 70:491–496

    Google Scholar 

  • Lam WL, Rawlins JM, Karoo RO, Naylor I, Sharpe DT (2010) Re-visiting Luck’s classification: a histological analysis of Dupuytren’s disease. J Hand Surg Eur 35:312–317

    Article  CAS  Google Scholar 

  • Landers PA, Yu GV, White JM et al (1993) Recurrent plantar fibromatosis. J Foot Ankle Surg 32:85–93

    PubMed  CAS  Google Scholar 

  • Ledderhose G (1897) Zur Pathologie der Aponeurose des Fußes und der Hand. Langenbecks Arch Klin Chir 55:694–712

    Google Scholar 

  • Luck JV (1959) Dupuytren’s contracture; a new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am 41:635–664

    PubMed  Google Scholar 

  • Mirabell R, Suit HD, Mankin HJ et al (1990) Fibromatoses: from surgical surveillance to combined surgery and radiation therapy. Int J Radiat Oncol Biol Phys 18:535–540

    Article  Google Scholar 

  • Mornex F, Pavy JJ, Denekamp J, Bolla M (1997) Scoring system of late effects of radiations on normal tissues: the SOMA-LENT scale. Cancer Radiother 1(6):622–668, Review. French

    Article  PubMed  CAS  Google Scholar 

  • Parnitzke B, Decker O, Neumann U (1991) Morbus Ledderhose. Die plantare Fibromatose – klinische Aspekte. Zentralbl Chir 116:531–534

    PubMed  CAS  Google Scholar 

  • Pentland AP, Anderson TF (1985) Plantar fibromatosis responds to intralesional steroids. J Am Acad Dermatol 12:212–214

    Article  PubMed  CAS  Google Scholar 

  • Pickren JW, Smith AG, Stevenson AG et al (1951) Fibromatosis of the plantar fascia. Cancer 4:846–856

    Article  PubMed  CAS  Google Scholar 

  • Rao GS, Luthra PK (1988) Dupuytren’s disease of the foot in children: a report of 3 cases. J Plast Surg 28:475–478

    Google Scholar 

  • Rödel F, Kamprad F, Sauer R et al (2002) Funktionelle und molekulare Aspekte der antiinflammatorischen Wirkung niedrig dosierter Strahlentherapie. Strahlenther Onkol 178:1–9

    Article  PubMed  Google Scholar 

  • Rödel F, Schaller U, Schultze-Mosgau S et al (2004) The induction of TGF-β1 and NF-κB parallels a biphasic time course of leukocyte/endothelial cell adhesion following low-dose x-irradiation. Strahlenther Onkol 180:194–197

    Article  PubMed  Google Scholar 

  • Rödel F, Hofmann D, Auer J et al (2008) The anti-inflammatory effect of low-dose radiation therapy involves a diminished CCL20 chemokine expression and granulocyte/endothelial cell adhesion. Strahlenther Onkol 184:41–47

    Article  PubMed  Google Scholar 

  • Sammarco GJ, Mangone PG (2000) Classification and treatment of plantar fibromatosis. Foot Ankle Int 21:563–569

    PubMed  CAS  Google Scholar 

  • Seegenschmiedt MH (2007) Morbus Dupuytren/Morbus Ledderhose. In: Seegenschmiedt MH, Makoski HB, Trott KR, Brady LW (eds) Radiotherapy for non-malignant disorders: contemporary concepts and clinical results. Springer, Berlin/Heidelberg/New York, pp 161–191

    Google Scholar 

  • Seegenschmiedt MH, Attassi M (2003) Strahlentherapie beim Morbus Ledderhose – Indikation, und klinische Ergebnisse. Strahlenther Onkol 179:847–853

    Article  PubMed  Google Scholar 

  • Seegenschmiedt MH, Katalinic A, Makoski HB et al (1999) Strahlentherapie von gutartigen Erkrankungen: eine Bestands­aufnahme in Deutschland. Strahlenther Onkol 175:541–547

    Article  PubMed  CAS  Google Scholar 

  • Seegenschmiedt MH, Olschewski T, Guntrum F (2001) Optimierung der Radiotherapie beim Morbus Dupuytren: erste Ergebnisse einer kontrollierten Studie. Strahlenther Onkol 177:74–81

    Article  PubMed  CAS  Google Scholar 

  • Strzelczyk A, Vogt H, Hamer HM, Krämer G (2008) Continuous phenobarbital treatment leads to recurrent plantar fibromatosis. Epilepsia 49:1965–1968

    Article  PubMed  CAS  Google Scholar 

  • Trott KR, Kamprad F (2006) Estimation of cancer risk from radiotherapy of benign diseases. Strahlenther Onkol 182:431–436

    Article  PubMed  Google Scholar 

  • Trotti A, Byhardt R, Stetz J, Gwede C, Corn B, Fu K, Gunderson L, McCormick B, Morrisintegral M, Rich T, Shipley W, Curran W (2000) Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys 47(1):13–47

    Article  PubMed  CAS  Google Scholar 

  • van der Veer WM, Hamburg SM, de Gast A, Niessen FB (2008) Recurrence of plantar fibromatosis after plantar fasciectomy: single-center long-term results. Plast Reconstr Surg 122(2):486–491

    Article  PubMed  Google Scholar 

  • Wapner KL, Ververelli PA, Moore JH et al (1995) Plantar fibromatosis: a review of primary and recurrent surgery. Foot Ankle Int 16:548–551

    PubMed  CAS  Google Scholar 

  • Wu KK (1994) Plantar fibromatosis of the foot. J Foot Ankle Surg 33:98–101

    PubMed  CAS  Google Scholar 

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Seegenschmiedt, M.H., Wielpütz, M., Hanslian, E., Fehlauer, F. (2012). Long-Term Outcome of Radiotherapy for Primary and Recurrent Ledderhose Disease. In: Eaton, C., Seegenschmiedt, M., Bayat, A., Gabbiani, G., Werker, P., Wach, W. (eds) Dupuytren’s Disease and Related Hyperproliferative Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-22697-7_50

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