Radiation and Dupuytren disease

Radiation treatment of Dupuytren disease has been reported in medical journals since the 1930s. It’s difficult to study because Dupuytren disease is so unpredictable and progresses so slowly.

Radiation is primarily recommended to prevent contracture in those who do not yet have contracture. The outcome of any preventative treatment has to be compared to the outcome of no treatment, what’s called the natural history of the condition. There’s very little data on the natural history of progression from Dupuytren nodules to contractures: only two published studies report specifically on this:
Data from these studies would predict that for people with a Dupuytren nodule but no contracture, one out of ten would eventually see their nodule go away without any treatment and less than two out of one hundred would progress to contracture each year. Many patients with Dupuytren disease never need treatment for Dupuytren contracture.

These numbers are essential to evaluation of the outcome of preventative radiation treatment for Dupuytren disease. Published studies on outcomes of radiation for early Dupuytren disease study report progression rates similar to or greater what was found in the above studies of no treatment.

There’s much anecdotal experience that radiation for Dupuytren disease reduces itching, tenderness, firmness of nodules, but, whether this translates to changes in rates of contracture progression – the bigger issue – is unclear. The lack of solid evidence despite many years of experience may have more to do with statistical difficulty studying Dupuytren disease than any lack of effect, but the reality is that available data does not show a strong difference comparing treated versus untreated outcomes. The logic behind radiation for Dupuytren disease is also complicated: the early effects of radiation are helpful for inflammatory, proliferative conditions such as the nodular stage of Dupuytren disease, but late effects stimulate fibrosis – exactly the opposite of what you would want for a fibrotic condition. In addition, Betz reported minor, but chronic issues of skin thinning and peeling in about one third of patients undergoing radiation for Dupuytren disease.

In 2015, doctors simply don’t have enough data for an evidence based recommendation regarding radiation as a routine prophylactic treatment to influence the rate of progression of Dupuytren contracture – one way or the other. Ultimately, it’s the patient’s choice. This choice depends on risk tolerance answering this question: which is more important – doing everything possible, or avoiding treatment which might have complications and no benefit? This is the essential question of consenting to any medical treatment. For some treatments (antibiotics for pneumonia), the answer is straightforward because treatment is very predictably low risk and high yield compared to no treatment. For others, such as radiation for early Dupuytren disease, the answer remains unclear.