Feasibility of aponeurectomy in combination with perioperative 192 Ir high dose rate brachytherapy for Dupuytren's disease

Strahlenther Onkol. 2021 Oct;197(10):903-908. doi: 10.1007/s00066-021-01801-5. Epub 2021 Sep 7.

Abstract

Purpose: Partial aponeurectomy (PA) is a standard procedure for Dupuytren's contracture (DC). Here we report a novel approach using surgery combined with perioperative high dose rate (192Ir-HDR) brachytherapy.

Methods and patients: From March 2018 until February 2020, thirteen rays of 6 patients with Dupyutren's contractures underwent PA followed by HDR brachytherapy. After removal of fibrous tissue and mobilization of the tendons, one to three catheters per patient were placed intraoperatively. Immediately after surgery, a planning computer tomography with 3D-planning was performed. Then 10-12 Gy were given to 0-2 mm from the catheters' surface and the catheters were removed 6-12 h after brachytherapy.

Results: No complications were observed. The mean contractures were reduced from 55.4° (standard error SE 19.6) to 15.4° (SE 6.7; p < 0.01). One patient showed progressive fibrosis of a nontreated ray during follow-up.

Conclusions: HDR brachytherapy in combination with surgery is feasible and harbors the potential for combined modality therapy to reduce relapse rates of advanced or relapsing DC. Controlled studies are warranted to investigate the role of bimodal therapy compared with PA alone.

Keywords: Aponeurectomy; Brachytherapy; Dupuytren’s contracture; Dupytren’s disease; Radiotherapy.