Non-malignant

PV QA 3 - Poster Viewing Q&A 3

TU_33_3012 - Treatment of Dupuytren's Contracture Using Electrons in the CT-based Treatment-planning Era

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Treatment of Dupuytren's Contracture Using Electrons in the CT-based Treatment-planning Era
N. J. DeNunzio, A. Ogrodniczak, and Y. Chen; Wilmot Cancer Institute, University of Rochester, Rochester, NY

Purpose/Objective(s): Dupuytren's contracture (DC), also known as Morbus Dupuytren or palmar fibromatosis, is a benign disorder with idiopathic fibroblast hyperproliferation of the palmar aponeurosis. In addition, there is a plantar equivalent (Ledderhose disease [LD]) that is less common. In its earlier stages, DC manifests as cutaneous nodularity, while more advanced disease can cause flexor contractures resulting in disability. Treatment options are varied, with the goal of halting or even reversing disease progression. Historically, orthovoltage x-rays have been effectively used as a non-invasive therapy. However, this was accomplished using a clinical setup with custom lead blocks and lack of precision on anatomy and treatment dosimetry. Here, we report treating DC of palm and sole at a single institution in the CT-based treatment planning era using electron beams, which allows for precise patient setup, delineation of both target and normal tissue volumes, and determination of dose delivered to both the target and bystander tissues.

Materials/Methods: Adult patients with a clinical diagnosis of DC treated in our department from 2014-2017 using at least one electron beam were included in this retrospective case series. Bolus of 0.5 - 1.0 cm was applied to the treatment site. Radiation was given once daily at a dose of 3 Gy per fraction to a total dose of 30 Gy with a planned break after the first half of treatment was delivered.

Results: Eight patients (13 extremities) were treated with a median follow up time of four months (range: zero to eight). Cohort characteristics included: median age 59 (range: 43-78), 75% male, at least 50% had a history of tobacco and/or alcohol use, and 50% had a family history of DC. Clinical presentation most often involved the fourth (77%) and fifth (46%) digits with no preference for laterality. Treated digits typically included the second through the fifth, although the thumb was sometimes included (38%). Median target depth maximum was 2.42 cm. A median dose of 28.8 Gy was delivered to 95% of the target volume with a median bone dose of 13.8 Gy and a median tissue hot spot of 121%. Of those patients with available post-treatment follow-up data, nearly all had evidence of disease improvement or stability. Acute toxicity was reported in 31% of treatments, none of which were higher than grade 1, while late toxicity was reported in only patient (edema).

Conclusion: Our data show that treatment of DC with electrons and CT-based planning allows for precise target delineation, prescription dose coverage, and minimal toxicity while also yielding similar cosmetic outcomes compared to treatment with orthovoltage x-rays. To increase follow up time and better understand patient-reported outcomes, a survey is being designed and phone interviews will be conducted.

Author Disclosure: N.J. DeNunzio: Employee; University of Rochester Medical Center. Honoraria; University of Rochester Department of Medicine, Boston University School of Medicine. Chief Resident/Instructor of Medicine; University of Rochester Medical Center. A. Ogrodniczak: None. Y. Chen: None.

Nicholas DeNunzio, MD, PhD

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