Radyoterapi ve Beslenme
Radiotherapy is primarily used in the treatment and ongoing management of cancer patients and their malignancies.
Radiotherapy is the use of ionising radiation in the treatment of cancer and is the ability of radiation to interact with the atoms and molecules of the tumour cells to produce specific harmful biological effects.
Ionisation affects either the molecules of the cells or the environment in which the cell lives; that is, there is sufficient energy from the radiation to cause changes within the cell.
The international unit for radiation dose is Gray (Gy).
Each type of radiation has its own unique characteristics. Your Radiation Oncologist will select different types of radiation dependent upon the area of the body they are treating.
For example, skin cancers are usually treated with electrons as they tend to deposit their energy on the surface.
X-ray tends to deposit most of its energy in deeper tissue and is therefore, for example, very useful in the treatment of prostate and cervical cancers. The benefit of x-ray therapy is that a high dose can be delivered directly to the cancer with minimal direct dosing to the skin.
How is radiation produced?
Most Radiation Oncology Departments have machines called linear accelerators which are capable of producing x-ray or electron radiation on demand.Once the machine is switched off, the radiation stops.
That is why cancer patients are not radioactive when they leave the treatment room and there is no risk to the people who come in contact with them.
In contrast are radioactive isotopes. These come as an oral or intravenous preparation.
For example, iodine – 131 which is used to treat overactive thyroids or thyroid cancer.
The radioactive isotopes can also be implanted directly into the tumour or into body cavities. This form of treatment is called brachytherapy. For example the implantable radioactive isotope wires Iridium-192 can be implanted into cancers of the tongue.Caesium-137 is another example of an implantable radioactive isotope used in the treatment of uterine or vaginal cancers in conjunction with other therapies, i.e. chemotherapy.
If radioactive isotopes are left inside the person they will of course continue to emit radiation.
Therefore there are strict guidelines that need to be adhered to such as the type of hospital room used for their stay, contact time with family and nursing precautions.
How does radiotherapy work?
The majority of the cells in our body contain DNA (Deoxyribonucleic acid). DNA is also the principle target of ionising radiation.
Radiation either directly disrupts the DNA activity or produces fast moving charged particles called radicals, which then disrupt the DNA activity.
Radiation tends to damage cancer cells more than normal cells because cancer cells are rapidly synthesising DNA, and hence have more targets for radiation. No doubt, some normal cells will also be destroyed and as a result side effects can occur.
Why does it take time for radiotherapy to work?
Radiation obviously has an immediate effect on the DNA and other targets. However, this does not immediately cause the irradiated cells to die. Even though the DNA is damaged at the standard dose of radiation used in cancer treatment, the rest of the cell structures remain viable and continue to work.
It is only when the time comes for the cell to divide that it finds the very blueprint for itself (ie. the DNA) faulty and thus it dies. It may be up to a month before the cancer cells attempt to reproduce and then die. (Please note however that in certain tissues, radiation does induce a rapid death by other mechanisms. i.e.
The radiation damages cells that are actively dividing. We often discuss the phases of cell division as the ‘The Cell Cycle’.
What does radiotherapy involve?
Radiation is directed to the area in which the cancer is located through either external beam or implants. Radiotherapy works in a similar way to chemotherapy, in killing the cells that are actively dividing through the damage of DNA.
Radiotherapy doesn’t have the systemic side effects seen with chemotherapy, but this is not to say that radiotherapy does not have side effects. The side effects of radiotherapy are localised to the site of the tumour.
For example, radiotherapy to a tumour in the neck may cause a sore throat but will not cause diarrhoea.
Radiotherapy is delivered either by external beam radiation, which is similar to the way an x-ray is taken (however in much stronger doses) by the insertion of radioactive implants (brachytherapy) or via isotope therapy.
Side effects of radiotherapy
As mentioned earlier, the side effects of radiotherapy are specific to the sites that are being treated. Potential for side effects increases with increasing duration of treatment, expected side effects usually appear 14 days after commencement of treatment and depend on dose, site and volume of treatment.
Some of these include:
- Acute nausea and vomiting;
- Inflammatory responses in irradiated tissues (e.g. mucositis, cystitis, proctitis);
Delayed side effects:
- Radiation fibrosis and specific organ damage: Any organ can be damaged with a sufficient dose. Some only need a low dose (e.g. lens);
- Sterility: gonads or pituitary;
- Secondary cancers.
Radiotherapy is not specific for cancer cells, and so can be dangerous to the normal cells of the patient. Procedures must always be followed that ensure the patient is only being exposed to the prescribed dose of radiation, and that this is being directed at the correct site.
Radiotherapy generally has less systemic side effects than chemotherapy because of this direction. For this reason, it is possible for a patient to lead a relatively normal life (including getting pregnant providing the cancer is not in the pelvic region) whilst receiving radiotherapy.
|For information on breast cancer, types of breast cancer and its investigations and treatments, as well as some useful videos, see Breast Cancer.|
|For information on prostate cancer, including diagnoses, types of treatments, and some useful tools, videos and animations, see Prostate Cancer.|
Combining radiotherapy and surgery
Radiotherapy can be given either before or after surgery. For instance, if surgery is not sufficiently extensive or there is a major risk of tumour recurrence, treatment is usually supplemented by giving radiotherapy after surgery. Before surgery, radiotherapy may be used to reduce a tumour.
Combining radiotherapy and chemotherapy
The most effective way to combine radiotherapy and chemotherapy is to give them at the same time because they reinforce one another’s effectiveness. This is called chemoradiotherapy.
It has improved treatment outcomes in many types of cancer, such as with certain lung cancers and cancers of the head and neck areas.
The simultaneous use of chemotherapy nevertheless increases the side effects of radiotherapy.
Planning radiotherapy takes into account not only your tumour but also information on the possible spread of the cancer.
Radiotherapy is completely painless and is targeted directly at the tumour or metastases. Radiotherapy is usually divided over a 2 – 8 week period. It is generally provided in small single daily doses five days a week.
Each treatment takes a few minutes. Dividing radiotherapy into several small parts reduces the harm caused to healthy tissue and improves the effectiveness of the therapy.
Patients usually go about their lives as normal during the period of treatment. In some cases accelerated radiotherapy may be given instead of phased radiotherapy. Radiotherapy is often a well-tolerated form of treatment, but it does have side effects.
Damage to the mouth and pharynx mucosa
Nearly all patients who receive radiotherapy to the head and neck area suffer damage to their mouth and pharynx mucosa. This is painful, makes it difficult to eat, is prone to infection and endangers dental health. Radiotherapy given to the area of the saliva glands may also cause dry mouth.
Damage to the mucosa in your mouth can be treated with preventive dental care, by treating infections, using painkillers and ensuring that you get sufficient nutrition.
Radiotherapy to your intestinal tract easily produces immediate side effects. Radiation given in the abdominal and pelvic area can cause nausea, diarrhoea and irritation of the bowel and rectal area.
The degree of damage depends on the composition of the area being treated and the size of the single and total dosage of radiation. Chemotherapy given at the same time increases and complicates the side effects. Radiotherapy given to the oesophagus can bring about a feeling of burning below the sternum, as well as pain and difficulty swallowing.
Following radiotherapy your skin may become reddened and peel. Skin redness may begin after 2 – 3 weeks and peeling generally after 4 – 5 weeks after the start of radiotherapy. Your skin may also become darker. It is important to protect the skin area under radiotherapy from sunlight, as your skin remembers the dose of radiotherapy it receives for your entire lifetime.
Blood cells are produced in the bone marrow contained in your larger bones. Radiotherapy given to the pelvic and spinal area may cause a drop in white blood cell, blood platelet and haemoglobin counts. This is usually temporary and your blood count will gradually improve.
External genital and bladder irritation
If a woman’s vulva and mucous membrane areas are given radiotherapy it may cause soreness. The areas are painful and may become infected.
Acute bladder irritation from radiotherapy occurs in the treatment of bladder cancer, endometrial cancer or prostate cancer. In this situation you feel a frequent need to urinate, there may be blood in your urine and you may have a distended lower stomach. Urinating may also be painful.
Late side effects of radiotherapy may occur in organs where tissue regeneration is slow. The doctors and physicists planning your radiotherapy know the sensitivity to radiation of different organs, and plan treatment so that late side effects can be avoided. But sometimes patients do experience late side effects from radiotherapy.
The most common late effect lung symptom is radiation-induced pneumonitis. This may occur after lung tissue has been subject to radiotherapy. The symptoms include cough, shortness of breath and fever. Radiation-induced pneumonitis occurs 1 – 6 months following radiotherapy. Cortisone is used to alleviate the symptoms. The symptoms usually disappear completely.
Radiation induced pulmonary fibrosis is another late effect that may occur in the lungs.Patients receiving brain radiotherapy may experience a syndrome including fatigue and headaches 2 – 6 months after treatment. Radiotherapy can also cause heart and blood vessel damage, which years or decades later may lead to the development of arterial disease.
Radiotherapy of the brain (fractionated)
Radiotherapy uses high-energy rays to destroy tumors and other diseases. Radiation works by damaging the DNA inside cells and makes them unable to divide and grow. Radiotherapy uses low dose beams to treat the tumor and a margin of normal cells surrounding the target area to prevent regrowth.
The type and amount of radiation that you receive is carefully calculated during a number of therapy sessions. Over time, the abnormal cells die and the tumor shrinks. Normal healthy cells can also be temporarily damaged by radiation, but are able to repair themselves.
The goal of radiotherapy is to maximize the damage to tumor cells and minimize injury to normal cells.
What is fractionated radiotherapy?
The benefits of radiation are not immediate but occur with time. Aggressive tumors, whose cells divide rapidly, tend to respond quickly to radiation. Over time, the abnormal cells die and the tumor may shrink. Benign tumors, whose cells divide slowly, may take several months to show an effect.
Radiotherapy is split into a number of treatments called fractions that are given over several weeks. Delivering a small fraction of the total radiation dose allows time for normal cells to repair themselves between treatments, thereby reducing side effects. Fractions are usually given five days a week with a rest over the weekend. Therapy sessions often take less than an hour.
The radiation beams are generated by a machine called a linear accelerator. The beams are precisely shaped to match the tumor and are aimed from a variety of directions by rotating the machine around the patient (Fig. 1). There are several types of machines, but they all do the same things:
- Precisely locate the target (tumor, lesion)
- Hold the target still
- Accurately aim the radiation beam
- Shape the radiation beam to the target
- Deliver a specific radiation dose
Figure 1. Radiotherapy shapes the radiation beam to match the outline of the tumor and includes a margin of normal brain to prevent recurrence. The beams come from many angles and intersect at the tumor to produce a high dose. The red ring shows the high dose and each outer ring represents lower and lower doses.
What's the difference?
|RadioTHERAPY 6-33 fractions||Delivers radiation at lower doses, over multiple days, and to larger areas. Treats a “margin” of brain tissue around tumors.|
|RadioSURGERY 1-5 fractions||Delivers radiation at very high doses, a few times, to a small area. Benefit is its rapid fall-off giving a less dose to normal cells.|
Doctors may recommend radiotherapy as a standalone treatment or in combination with surgery, chemotherapy or immunotherapy. Radiation may be given after surgery to stop the growth of tumor cells that remain. If eliminating the tumor is not possible, radiation can be used to relieve pain, seizures, or other symptoms.
Who is a candidate?
You may undergo radiotherapy if you have a:
- Primary brain tumor: glioma, glioblastoma, astrocytoma, lymphoma
- Benign tumor: acoustic neuroma, pituitary adenoma, meningioma, craniopharyngioma, glomus tumor
- Metastatic tumor: lung, breast, skin or other cancer that has spread to the brain.
Who performs the procedure?
Radiation oncologists are doctors who have special training in treating cancer and other diseases with radiation. The radiation oncologist works with a team that includes a surgeon, medical physicist, dosimetrist, radiation therapist, and oncology nurse.
The surgeon and radiation oncologist decide what techniques to use to deliver the prescribed dose. The physicist and the dosimetrist then make detailed calculations and set up the equipment. The radiation therapists position you on the machine and deliver the treatments.
The nurse provides care and helps you manage any side effects.
What happens before treatment?
Your first appointment is a consultation with a radiation oncologist. He or she will perform a physical exam and reconfirm your diagnosis the imaging studies (CT, MRI) and pathology reports.
They will discuss with you the best type of radiation treatment for your particular tumor or lesion, explain the treatment process, and describe possible side effects.
Once you've decided to go ahead with treatment, you will sign consent forms.
Figure 2. A thermoplastic mask is custom-fit to the contours of your face. The front and back pieces of mesh are secured to a U-shaped frame that attaches to the treatment table to hold the head still.
Step 1: create face mask
At your next appointment, a custom-made stereotactic mask will be made to fit your face exactly. It will be used during imaging and each treatment session to hold your head perfectly still. You will lie with your head on a cradle of mesh stretched between a U-shaped frame.
Next, strips of stretchy plastic are placed across your forehead, under your nose, and over your chin. You will be asked to bite a small piece of plastic with your front teeth. Next, thermoplastic mesh is dipped into a water bath, making the mesh very flexible. The mesh is placed over the face and allowed to conform (Fig. 2). You will be able to easily breathe.
Cold mitts help the mesh cool and harden. Creation of the mask takes about 30 minutes.
Step 2: simulation
Once the facemask is created you will undergo imaging scans, called a CT simulation, to carefully plan your radiation treatment.
Reflective balls are placed on the facemask and worn during the CT scans (Fig. 3). These markers appear on the scan and help pinpoint the exact three-dimensional coordinates of the target within the brain.
It may be necessary to obtain a new MRI scan.
After the scan, the facemask is removed and you may go home. The doctors continue with step 3 (treatment planning), and you will return within a week or so to begin treatment.
Figure 3. Reflective balls are placed on the facemask prior to CT scanning. Markers are seen on the CT scan and help pinpoint the exact coordinates of the tumor or lesion.
Step 3: treatment planning Information about the tumor's location, size, and closeness to critical structures is gathered by the CT or MRI scan. Advanced computer software uses the scans to create a 3D view of your anatomy and the tumor (Fig. 4). Using the software, the radiation oncologist, surgeon, and physicist work as a team to determine the:
- appropriate target or targets
- radiation dose and number of treatment sessions
- number and angle of treatment beams
- size and shape of the beams to exactly match the tumor or target
Each individual beam is too weak to damage the healthy brain as it passes through on its way to the target. But at the intersection of all the beams, the energy dose is strong enough to destroy the tumor.
What happens during treatment?
About a week after the simulation you will return to the center for your first treatment. The nurse or radiation therapist will escort you to a holding room, where you may need to change into a gown.
Figure 4. The computer creates a 3D view of your anatomy. A treatment plan determines the number and angle of beams, the size and shape of the radiation beams, and the radiation dose.
Step 4: position the patient
After the radiation machine is calibrated and prepared for your specific treatment plan, you will lie on the table. The mask is placed over your face and secured to the table. If you have a head frame, it is secured to the treatment table.
Alignment lasers and x-rays help to position you correctly. Stereoscopic x-rays are taken and compared to the treatment plan. Any misalignments are corrected before treatment.
Figure 5. The facemask is secured to the treatment table and holds the patient’s head perfectly still and positioned in the treatment field. The machine rotates around the patient, aiming radiation beams at the tumor.
Step 5: deliver the radiation
The therapist leaves the room and operates the machine from the control room. The team watches you through video monitors and speaks to you over an intercom. The machine and treatment table move every so often to deliver radiation beams from one or more directions (Fig. 5).
The machine is large and makes a humming noise as it moves around your head. Its size and motion may be intimidating at first. It may pass close to your body, but it will not touch you. You do not have to hold your breath—just breathe normally. Treatment may take 30 minutes or longer, depending on the complexity of the target.
What happens after treatment?
After treatment the therapist releases the facemask from the table and helps you get up. The facemask is stored at the center for your next session. You will return each day at your scheduled time to repeat steps 4 and 5 until all fractions of the complete dose are delivered.
Recovery and prevention
Side effects of radiation vary, depending on the tumor type, total radiation dose, size of the fractions, length of therapy, and amount of healthy tissue in the target area. Some side effects are temporary and some may be permanent. Ask your doctor about specific side effects you may experience. General side effects may include:
Fatigue is common. You may feel more tired than usual for a few weeks following treatment. Fatigue can continue for weeks or months after treatment stops. Save your energy for important obligations and allow others to assist with chores or errands.
Make sure you get plenty of sleep, take a nap after treatment, and eat a balanced diet. Some patients may need to increase their caloric and protein intake because their bodies are working hard to repair itself. Some patients may notice a lack of appetite and a loss of taste.
Exercise and/or stretching can also help you to combat fatigue. A short, brisk walk can be rejuvenating and can give you a boost.
The skin at the areas where the radiation beams pass through may become slightly red and dry. This will go away after treatment stops.
Left untreated, skin irritation may lead to an infection.
You may experience hair loss in the treated area about two weeks after treatment begins. Hair will often grow back after treatment stops, though in some cases the regrowth may be incomplete.
To prevent further hair loss, use a mild shampoo (not harsh or fragranced) when bathing. Soft hairbrushes and low heat while blow-drying will also help prevent further damage to your hair.
Because areas exposed to radiation tend to sunburn easily, patients should protect those areas by applying sunscreen or wearing a wig, hat, or scarf.
Radiation causes tumor cells to die. The body's natural response to cell death or injury is swelling. Edema is extra fluid, or swelling, within the tissues of the brain.
If brain swelling occurs, it can cause headaches, weakness, seizures, confusion, or speech difficulty. It may also worsen the symptoms that were present before treatment. If you start to feel uncomfortable with headaches or any other symptoms, discuss this with your radiation oncologist.
Steroid medication (dexamethasone ) may be given to reduce brain swelling and fluid within the tumor. Steroids should always be taken with food to protect your stomach and prevent nausea.
Steroids can also affect the normal bacteria in your mouth and cause a yeast infection called thrush – whitish patches on the tongue. Do not abruptly stop taking steroids. A tapering schedule is required to avoid withdrawal.
What are the risks?
In rare cases, radiotherapy may cause the center of the tumor to become necrotic (dead). Radiation necrosis can happen anytime, but it most often occurs 6 to 12 months after radiotherapy.
This dying tissue can become toxic to surrounding normal brain, and swelling may occur. Radiation necrosis may look similar to a regrowing tumor on an MRI scan. Special tests such as PET scan or MR spectroscopy/perfusion may help to tell between active tumor and necrosis.
However, sometimes these tests are not definitive. Treatment for radiation necrosis may include:
- Medicines that reduce inflammation, 5-LOXIN (Boswellia serrata).
- Hyperbaric oxygen therapy (treatment in an oxygen chamber) may be prescribed to help damaged brain tissue heal.
- A drug called bevacizumab (Avastin) may be given if other treatments are not effective.
- In some cases, surgery may be needed to remove the necrotic tissue.
What are the results?
After all radiotherapy sessions are done, MRI scans will be taken periodically so that your doctors can look for signs of response.
Several months may pass before the effects of treatment are visible. Some tumors may be completely eliminated with radiation. For others tumors the goal is to stop or halt the growth.
In some cases the tumor may not shrink, but still be considered “controlled.”
If you have questions, please contact Mayfield Brain & Spine at 513-221-1100 or 800-325-7787.
benign: not cancerous.
fractionated: delivering the radiation dose over multiple sessions.
metastatic: a cancerous tumor that has spread from its original source.
stereotactic: a precise method for locating structures within the body through the use of 3-dimensional coordinates.
target: the area where radiation beams are aimed; usually a tumor ormalformation.
reviewed by > Ronald Warnick, MD, Mayfield Clinic, Cincinnati, Ohio
Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.
Radiation therapy of Morbus Dupuytren and Ledderhose disease
Radiation therapy (radiotherapy) is a non-surgical treatment that can stop or slow down Dupuytren's disease in its early stage. In radiation therapy, the nodules and cords associated with Dupuytren's are irradiated from a distance of .5 – 1 cm either with X-Rays (e.g. 120 kV) or with electrons (3 – 10 MeV).
This is typically done over five days in a row applying an efficient dose (single dose 3 Gy, total dose 15 Gy). After a break of 6 -12 weeks, this treatment is repeated. Typically this softens the nodules (and somtimes also cords) and prevents contraction of the hand.
Recently research showed that a total dose of 20 Gy has nearly the same effect (see literature).
An expert diagnosis prior to radiotherapy is important!
Prior to radiotherapy the to be irradiated area has to be defined by the physician. Because RT is usually not repeated it is very important that all sites of Dupuytren's in the hand are identified and included within the irradiated area.
At the same time not diseased areas are usually not irradiated to minimize risk of cancer and to allow later treatment in case DD should start in those areas. MRIs are rarely required for diagnosis but an experienced physician will be able to palpate even tiny nodules and cords.
Below picture illustrates the difference between a patients finding (left) the result of the physician's palpation (right).Nodules and cords identified by the patient (left) and the additional findings of the physician (right).
(Picture published with agreement by the patient and H. Seegenschmiedt, Strahlenzentrum Hamburg Nord, Germany)
Where radiotherapists have limited experience in diagnosing Dupuytren's it might be feasible to consult an experienced hand surgeon for marking the nodules.
|The irradiated area is marked on the hand.||The hand is ready for treatment. Note that there is no shielding required.|
Setup for radiation therapy of Dupuytren's disease (Dupuytrens) with X-rays. The patient is shielded from radiation by the equipment itself, by a lead mask between the x-ray conus and the hand (defining the radiated area), the material under the hand, and the lead apron.
(Picture provided by H. Seegenschmiedt, Strahlenzentrum Hamburg Nord, Germany)
Positive effects of radiotherapy
Radiotherapy is capable of stopping the growth of Dupuytren nodules either permanently or for a long time. Occasionally, small nodules will even shrink or disappear. Radiotherapy is much less effective on cords and cannot make an already bent finger straight again. Below is a graph from a presentation by Seegenschmiedt et al.
at the ASSH meeting 2006 illustrating how radiation therapy delays disease progression and in favorable cases can render surgery unneccessary. Blue lines indicate the disease progression after radiotherapy, the dotted line indicates a potential healing effect in early stage treatment (for details please refer to the full presentation).
Radiotherapy – when to apply best?
The effectiveness of radiotherapy depends on the stage of the disease. It is very promising in the early nodular stage where the nodules are relatively small.
Research at the University of Erlangen, Germany, showed the following: ten years after the therapy, for 84 percent of the patients having Dupuytren in stage N (just nodules and cords) and 67 percent of stage N/I (hand bent by 1-5°), the disease either had not progressed or had actually improved (Adamietz et al. “Radiotherapy in Early Stage Dupuytren's Contracture”, see literature). The success rate becomes much lower in later stages. Overall, radiation therapy seems to be able to stop or significantly slow down Dupuytren's disease in the early stage. If it doesn't, surgery, NA or collagenase injection are still possible.
Long-term results from Betz et al. (“Radiotherapy in Early Stage Dupuytren's Contracture – Long Term results after 13 Years” 2010 literature) clearly demonstrate the advantage of early treatment. It is most effective to treat the Dupuytren's nodule within the first year, probably best as soon as possible (status idem = stable, no change):
One of the difficulties of radiation treatment is that only a few people consult their doctor in the very early stage of Dupuytren's, when the nodules are only a few millimeters in diameter and when radiation treatment is most beneficial. Another problem is that radiotherapy as a means for treating Dupuytren's disease is not widely known.
Who should be treated?
It is important to understand that not every patient with Dupuytren's nodules will experience contracture. Seegenschmiedt et al. abstract compared patients treated with radiotherapy (21 and 30 Gy) and an untreated control group with an average follow-up of 8 years.
In that period the extension deficit increased for 35% of the patients in the untreated group and in 7% (21 Gy) and 4% (30 Gy), respectively, in the treated groups.
But that also means that over 8 years of observation 2/3 of the untreated patients experienced no increase of their extension deficit. People who develop initial signs of Dupuytren's at the age of 70 or later will often not need treatment at all.Prevalence considerations indicate that the percentage of people with symptoms of Dupuytren disease who never need any kind of treatment, maybe even be higher, up to 85%.
Clear guidelines for who should be treated by radiotherapy and who not are still missing. Treatment by radiotherapy probably makes sense for patients with aggressive Dupuytren's where RT can slow down or halt disease progression and who otherwise would have to face later surgery or frequent minimally invasive treatments.
The aggressiveness of Dupuytren's disease may depend on several factors, one of them being age. Patients with a dormant disease or low probability for recurrence might get along well with a “wait and see” strategy.
As radiotherapy of Dupuytren and Ledderhose disease often also relieves pain, patients suffering from painful disease might also be potential candidates for radiotherapy.
Additional detailed consideration and information on radiotherapy (specifically at a Hamburg clinic) are provided by a patient (Alastair Cook) on dupuytrensradiotherapy.
Radiation therapy – how does it work?
Dupuytren's disease and Ledderhose disease start with fibrous tissue in form of nodules that, specifically in its initial stage, is biologically very active (“proliferative”).
in wound healing this tissue maturates (building cords for Dupuytren's) and eventually contracts (actively or passively fixing a contraction). The initial proliferating stage is most suitable for radiotherapy.
Radiotherapy seems to be able to affect the development of the involved fibroblast and myofibroblast cells (in other terms the involved growth factors) and reduce their growth rate. There is indication that this is achieved by affecting the development paths of the myofibroblast cells.As the growth of a nodule is the net effect of building new cells and of removing dead cells, the slowing down of the growth of new cells can result in shrinking and softening of the nodule.
– While there is a variety of publications on the macroscopic results of radiotherapy of Dupuytren's, the understanding of the radiobiological proccesses is still a matter of basic research. For more details please refer to “Introduction to radiation biology when treating hyperproliferative benign diseases” link , or literature (section 184.108.40.206. of “Radiotherapy for Non-Malignant Disorders”, and the Degro 07 paper by Blaese and Rodemann).
Further questions and answers
Questions by patients have been discussed in our forum and you might find below answers interesting (mostly by Prof. Heinrich Seegenschmiedt from Essen, Germany).
Planning of RT
Definition of Dupuytren's Disease progression
Clinical examination of Dupuytren's prior to RT
Appropriate size of field
Typical reactions after RT
Aftercare following RT
Treatment of DD after RT (re-radiation)
RT after surgery
Above comments apply for Ledderhose accordingly. Because Ledderhose shows less cords but mostly larger nodules, radiation therapy is applied to those larger nodules as well.
Below is an example of an x-ray treatment showing how lead shielding is applied for limiting the radiated area (shielding of electron beams is more difficult, therefore typically the whole area is radiated).
Below pictures were provided by Dr. Herkströter of Städtische Kliniken Frankfurt.
Marking of nodule (dotted, center) and to be radiated area prior to treatment.
Protecting the surrounding area with a lead shield prior to x-ray treatment.
Treatment position. X-ray equipment applied.
(pictures provided by Städtische Kliniken Frankfurt/M.-Höchst)
Example of treatment results, provided by a patient:
Before radiotherapy the nodule or nodules extend over a large area of the arch.
After radiotherapy the nodule is not gone but reduced in size.
Patient's comment: “I'm really satisfied about my condition nowadays. Even the walking difficulties and pain got much better.”
Page last modified: 03/25/2019