Dupuytren’s Contracture
Dupuytren’s contracture is a benign (non-cancerous) condition that affects the connective tissue in the palm of your hand and fingers.
It typically starts as one or more small lumps in your hand. These lumps grow and cords develop along the tendons of your fingers. If left untreated, they can cause your fingers to bend towards your palm until they’re no longer able to straighten – this is called a contracture. This can restrict your movement and ability to perform everyday tasks.
Radiotherapy for Dupuytren’s Contracture
Radiotherapy is an effective treatment option for early-stage Dupuytren’s contracture, when there is minimal or no contracture of your fingers, and if things have worsened over the last 12 months, for instance with growth or increased number of nodules, growth of cords, pain or tighter fingers.
If your contracture is at an angle greater than 20 degrees, radiotherapy is less likely to be the best treatment for you so your doctor may recommend alternative options.
Radiotherapy is the use of radiation (for instance with X-rays) to treat disease. Using low doses of radiation directed towards the nodules (lumps) in your hands, the development and growth rate of the cells is reduced. This causes the nodules to soften and shrink, and prevents the formation of contractures – the permanent inability to fully straighten the fingers.
Effectiveness of Radiotherapy
A recent study looked at the outcomes of patients who had received radiotherapy for progressive Dupuytren’s contracture and compared it with patients who chose to be observed rather than treated. Patients who received radiotherapy saw a significant reduction in disease progression and a lower need for surgery compared to the group who did not.
Overall, patients who received radiotherapy for the treatment of Dupuytren’s contracture were over three times less likely to see their condition progress or require surgery compared to those that chose to only have their condition observed.
How the treatment works:
Your initial consultation. You will see a doctor who will ask you questions about your condition, examine your hands, and discuss treatment options with you, including the benefits and possible side effects of radiotherapy.
If you decide to move forwards with radiotherapy, you’ll need to sign a consent form for your treatment.
Your doctor will then outline the nodules and cords which are to be treated – a safety margin will be marked around the tissue to be treated – this allows us to treat the affected area while protecting the unaffected part of your hand.
A radiographer will then take a photograph of the region and make a tracing so that the area can accurately be treated each day. In some centres, a CT scan may be used to design the treatment plan. The treatment will generally start around a week or two later.
Treatment. You’ll be asked to position yourself underneath the radiotherapy machine with your hand placed on a positioning bag for the duration of the treatment session.
Each appointment will take around 10 minutes, with the radiotherapy treatment itself taking a few minutes to complete. You can leave straight away when each session is complete. Your treatment will be administered over five consecutive weekdays and then repeated after a break of around three months
The radiotherapy will be targeted to the same area throughout your course of treatment, even if the nodules in the hand seem to be decreasing in size. This is to limit the likelihood of regrowth.
Follow-up. You’ll receive a follow-up call from the treatment centre to check how you are doing after your treatment. Here you can discuss any problems, side effects or questions you may have.
Three months after your treatment, you’ll be sent a questionnaire so we can assess how your hands are. If necessary, you’ll be able to have an additional consultation over the phone, or at one of our clinics, to discuss your outcomes in more detail.
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Conditions We Treat
FAQ
Most Commonly Asked Questions
You shouldn’t feel any pain during your radiotherapy treatment, however, you may be a little tired afterwards.
The indications for radiotherapy depend on the particular condition that you have. Your doctor will discuss whether radiotherapy is the right treatment for you, explaining the effectiveness and the side-effects involved.
A physician referral is generally needed if you are using private medical insurance. If you are self-funding then generally you do not need a referral letter, although we will routinely send a copy of any letters that we write to your physician, for instance, a record of the consultation and the treatment.
You may experience some minor side effects after radiotherapy treatment. Your specific risk will be discussed with you during your initial consultation. During your treatment, you shouldn’t experience any pain, drowsiness or dizziness.
It’s important to note that the radiation dose is much lower than radiotherapy treatment for cancer, so that side effects tend to be mild.
You may find that in the two to three weeks after the end of your radiotherapy course, the skin on your palm, for example, may become a little red, sore or dry. This tends to be very minor, although about 1 in 100 people can get swelling or weeping around the area. Most people find putting some moisturiser around the treatment site is enough to treat the dryness.
Around one in five people find that the dryness continues in the long term. Some people notice minor changes in the skin and it may become thicker, thinner, rougher, or smoother than before the treatment.
While there is a theoretical risk of developing a cancer in the skin around the treated area, the risk is very small.
For a 50 year old, the life-time risk of developing a type of skin cancer in the treated region is in the region of 0.02% to 0.1% (between 1 in 5,000 patients and 1 in 1,000 patients). The risk of cancer will be slightly higher if you are younger and lower if you are older at the time of treatment. Your specific risk will be discussed in detail with your consultant.
Since the radiation is precisely targeted at the area, this avoids unnecessary exposure to the rest of your body and so there is no increase in cancer risk outside of the treated area.
If you have any concerns during your treatment, your radiographer or consultant will be available to answer your questions at any time.
