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

Abstract

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. 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\u202fGy were given to 0–2\u202fmm from the catheters’ surface and the catheters were removed 6–12\u202fh after brachytherapy. No complications were observed. The mean contractures were reduced from 55.4° (standard error SE 19.6) to 15.4° (SE 6.7; p\u202f<\u20090.01). One patient showed progressive fibrosis of a nontreated ray during follow-up. 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.