What are the side effects of radiation therapy for Dupuytren's (Dupuytren's contracture) contracture?

Side Effects of Radiation Therapy for Dupuytren's Contracture

Radiation therapy for Dupuytren's contracture is generally well-tolerated with minimal acute and late toxicities, primarily limited to mild skin reactions that rarely progress to serious complications.

Acute Side Effects

• Skin reactions: The most common acute side effects are skin-related:

  • Grade 1 reactions (mild erythema, dry desquamation) occur in approximately 38% of treated hands 1
  • Grade 2 reactions (moderate erythema, patchy moist desquamation) occur in about 6% of cases 2
  • These reactions are typically mild and self-limiting, resolving within weeks after treatment

• Timing: Skin reactions typically manifest within 2-3 weeks of starting radiation and may increase for 1-2 weeks after radiotherapy completion before gradually resolving over 3-4 weeks 3

Long-Term Side Effects

• Chronic skin changes: After long-term follow-up (mean 13 years):

  • Skin dryness/atrophy occurs in approximately 32% of patients 4
  • These changes are generally well-tolerated and don't significantly impact quality of life 5

• Other potential late effects:

  • Dryness
  • Desquamation
  • Skin atrophy
  • Changes in sensation (LENT Grade 1) in about 5% of treated sites 2

Efficacy and Disease Control

• Radiotherapy is effective in preventing disease progression in early-stage Dupuytren's:

  • In stage N (nodules/cords without extension deficit), 87% of cases remain stable or regress 4
  • In stage N/I (≤10° deficit), 70% remain stable or regress 4
  • More advanced stages show higher progression rates despite treatment

• Long-term studies show:

  • 77% of patients experience no disease progression after 5+ years 6
  • Only 11% progress according to stage in long-term follow-up 7

Treatment Protocol Considerations

• Standard treatment involves:

  • Two courses of 5 × 3 Gy (total dose 30 Gy) separated by 6-8 weeks 4, or
  • Alternative protocol of 7 × 3 Gy (total dose 21 Gy) in a single series over 2 weeks 2
  • Both protocols show similar efficacy at 1-year follow-up

• Orthovoltage radiotherapy (120 kV) is typically used with individual shielding of uninvolved areas of the palm 2

Important Considerations

• No evidence of radiation-induced malignancy: After mean follow-up of 13 years, no second malignancies attributable to radiotherapy have been reported 4

• No impact on subsequent surgery: If disease progresses despite radiotherapy, "salvage" surgery remains feasible without increased complications 4

• Patient selection: Radiotherapy is most effective in early stages (N and N/I) before significant contracture develops 4, 5

• Treatment timing: Early intervention is crucial for optimal outcomes, as more advanced disease (stages I and II) shows significantly higher progression rates despite treatment 4

The evidence strongly supports radiation therapy as a safe option for early Dupuytren's contracture with minimal side effects that are generally well-tolerated by patients. The benefit of preventing disease progression in 70-87% of early cases outweighs the risk of mild skin toxicity that occurs in some patients.