Common Benign Diseases Treated with Radiation Therapy

Dupuytren’s Contracture

“The International Dupuytren Society considers radiotherapy as a very effective, if not the only, means to stop Dupuytren’s disease in an early stage and to possibly avoid later surgery.” http://www.dupuytrensdiseasesupportgroup.com/welcome.html
(http://www.dupuytren-online.info/index.html)

We now have phase III data to show superiority to observation (Seegenschmeidt et al, PMID 11172962).

Patients appropriate for radiation therapy include those with nodules only or less than 10 degrees of contracture. Patients with more advanced disease can receive radiation therapy after a corrective procedure in order to prevent re-contracture. We work closely with local orthopedic surgeons to offer this therapy to our community.

In a study covering 13 years of follow-up, Betz et al. observed only minor side effect including skin atrophy and skin peeling for 32% of the patients. No radiation burns were observed.

“No single case of cancer caused by radiation has ever been reported after the use of RT for Ledderhose, Dupuytren’s, Keloids, hypertrophic scars, or other benign hyperproliferative disorders” which had been a theoretical concern.

Tri-Cities Cancer Center is the only radiation therapy clinic in Washington State certified by the International Dupuytren’s Society.

DDSG - Dupuytren's Disease Support Group

DART - Dupuytren's Advocates for Radiation Therapy

shutterstock_188634710 http://www.dupuytrensdiseasesupport.com/

Dr. Guy Jones is actively involved in supporting patients with Dupuytren's, Ledderhose, and Peyronie's Diseases and serves as a forum expert physician on the Dupuytren's Disease Support Group.  The group has just announced their new grassroots campaign to raise awareness of the diseases: http://www.prweb.com/releases/2016/03/prweb13248714.htm

Ledderhose Disease

Ledderhose Disease (aka Plantar fibromatosis) is a condition very similar to Dupuytren’s disease, but occurs on the feet.  The disease is characterized by the growth or nodules which may slowly spread along the tendon of the foot.

Patients may report feeling as if their sock is bunched up in their shoe or have a feeling of walking on rocks.  As the disease progresses, it can become painful, leading to patients forgoing activities such as running or long walks.

As with Dupuytren’s disease, Ledderhose is very responsive to radiation therapy.  Nodules typically soften and shrink, allowing for increased function and mobility.

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(Before (left) and after (right) treatment.) http://www.dupuytren-online.info/radiation_therapy.html

Keloids

Keloidectomy followed immediately by a small dose of radiation consistently decreases recurrence of keloids to only ~10-15% (PMID: 26430630, 26224888, 26137265, 25907802).

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Plantar Fasciitis

Very small doses of RT to the sole of the foot have been shown to decrease the pain associated with painful heel spurs with minimal side effects (PMID 26281833).

Treatment:
A very small dose of radiation is given to the foot twice per week for 3 weeks.  The treatment is completely painless.

Results of Treatment:
83% of patients report significant pain relief by 6 weeks after the treatment and over half report complete resolution of pain.  Pain relief lasts an average of 72 months (Miszczyk, et al. TBIR, 2014).

Radiation vs Steroid Injections:
Compared with steroid injections, radiation therapy was shown to be superior in both effectiveness of treatment and duration (Canyilmaz, et al. IJRO, 2015).

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Epicondylitis (tennis elbow/golfer’s elbow)

Very small doses of RT to the elbow have been shown to decrease the pain associated with tennis elbow with minimal side effects.

Treatment:
A very small dose of radiation is given to the elbow twice per week for 3 weeks.  The treatment is completely painless.

Results of Treatment:
A recent study of 2,000 patients with medial or lateral epicondylitis treated with radiation also demonstrated highly effective pain control. (Ott et al, Strahlenther Onkol, 2012).

Tennis Elbow

Trigeminal Neuralgia

A single fraction of stereotactic radiosurgery has been shown to reduce the occurrence of painful episodes in 70-90% of patients that have insufficient response to conservative management. The Varian Edge at the Tri-Cities Cancer Center has the accuracy necessary to provide this treatment in the Tri-Cities without the need for invasive (bolted) head frame placement.

Chen, et al. Treatment of trigeminal neuralgia with linear radiosurgery: initial results.  J Neurosurg. 3:346-50.

Frighetto, et al. Noninvasive linear accelerator radiosurgery as the primary treatment for trigeminal neuralgia. Neurology. 62:660-662.

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Acoustic Neuroma

Both stereotactic radiosurgery and standard fractionated radiation demonstrate very favorable outcomes in the management of acoustic neuroma/vestibular schwannoma. Generally, radiation therapy is preferred in cases where patients have hearing function as it results in excellent hearing preservation rates.

Karpinos, et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys. 54:1410-21.

Meijer, et al. Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys. 56:1390-6.

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AV-Malformations

Stereotactic radiosurgery for arteriovenous malformations may be used in cases where surgery is considered too risky such as an inaccessible location or expected high morbidity due to location, large size, or medically inoperability. The goal of SRS is to eliminate or reduce the risk of catastrophic hemorrhage. It can take 2 or more years for full destructive effect and the risk for hemorrhage is reduced during this time. Durable control rates after 2 years for lesions <3cm are 80-90%.

Wang, et al. Linear accelerator stereotactic radiosurgery in the management of intracranial arteriovenous malformations: long-term outcome. Cerebrovasc Dis. 37:342-9.

Dalyai, et al. Stereotactic radiosurgery with neoadjuvant embolization of larger arteriovenous malformations: an institutional experience. Biomed Res Int. 2014:306518.

Maruyama, et al. The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations. N Engl J Med. 352:146-53.

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Photo courtesy of the National Institute of Health.

Sialorrhea

Up to 80% of patients with Parkinson disease and 30% of patients with ALS suffer from sialorrhea, or excessive salivation. Patients who fail conservative medical management can be considered for 1-4 fractions of radiation therapy with studies reporting 80-95% improvement in patient reported symptomatic outcomes.

Hawkey, et al. The role of radiation therapy in the management of sialorrhea: A systematic review. Laryngoscope. 126:80-5.

Slade, et al. Managing excessive saliva with salivary gland irradiation in patients withamyotrophic lateral sclerosis.J Neurol Sci. 352:34-6.

Assouline, et al. Radiation therapy for hypersalivation: a prospective study in 50 amyotrophic lateral sclerosis patients. Int J Radiat Oncol Biol Phys. 88:589-95.

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Photo courtesy of the National Institute of Health.