Long-Term Effects of Radiation Therapy for Benign Conditions of the Hand
Kalila Steen, MD1; Victoria Hayward, MD1; Christine B Novak, PT, PhD2; Dimitri J Anastakis, MD3; Steve McCabe, MD, MSc4; (1)University of Toronto, Toronto, ON, Canada, (2)Toronto Western Hospital Hand Program, University Health Network, Toronto, ON, Canada, (3)Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada, (4)Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
Introduction There is increased interest in the use of radiation for benign hand conditions. Emerging literature introduces radiation therapy for Dupuytren's contracture and recurrent giant cell tumor of the tendon sheath (GCTTS). Despite promising early literature, hand surgeons are wary recommending radiation therapy for non-malignant conditions. In our practice, we have used radiation therapy for recurrent GCTTS and to prevent recurrence after treatment of Dupuytren's contracture in patients with strong diathesis. The purpose of this study is to examine the long-term effects of radiation to the hand through the critical lens of a hand surgeon.
Materials and Methods
Patients who received radiation therapy for GCTTS were reviewed in clinic with special attention to subsequent radiation effects on the hand. The Radiation Oncology Toxicity Grading (ROTG) Late Radiation Morbidity Scoring Schema was measured, and patients were questioned about symptoms and examined for physical findings involving their irradiated digits.
A total of 6 GCTTS patients (2 men and 4 women) with a history of radiation therapy to the hand (48 Gy in 24 fractions) presented for follow-up to examine for long-term effects of radiation. The average patient age was 59.6 years (range 42-74 years), and the average time since radiation therapy was 5.6 years (Range 9 months – 11 years and 1 month). Patients had an average of 2.3 surgeries (range 1-4) on the affected digit prior to receiving radiation therapy. The average Disabilities of the Hand, Shoulder, and Arm (DASH) score was 10.8 (range 0-28). All patients had some erythema present at the site of radiation (see figure). Other common signs of radiation included skin dryness, nail changes, and skin atrophy. All patients complained of sensation changes, although only 2 of the 6 patients had abnormal moving two-point discrimination tests. There were no confirmed recurrences of GCTTS and no evidence of skin cancers.
Patients who received radiation therapy to the hand report exceptionally high levels of satisfaction with the therapy. In our small sample, the negative effects of radiation did not seem to worsen with time. Overall, radiation therapy is tolerated well by these patients and has a low level of long-term morbidity in our population.
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