2822 - Patient-Reported Outcomes Following Radiotherapy for Extremity Fibromatosis: A Single Institution Retrospective Cohort Review

Purpose/Objective(s): Fibromatosis of the hands (DD, Duputryen’s Disease) and feet (LD, Ledderhose’s disease) is a condition characterised by the overgrowth of fibrous connective tissue, causing benign and locally aggressive fibromas. According to the Royal College of Radiology (RCR) guidelines, radiotherapy can be offered for early-stage DD and symptomatic LD. We evaluated clinical outcomes, fibroma recurrence and toxicity following primary RT for DD and LD.

Materials/Methods: Patients with DD or symptomatic LD treated with RT between 2018 and 2025 were included and grouped by disease site. Eligibility criteria included adults with clinically confirmed fibromatosis of the extremities, and hand contracture <10 degrees for DD. Patients were set-up in a custom-made immobilization system and received 30Gy/10 fractions split in two parts twelve weeks apart. Electrons, kV or Photons were used depending on the thickness of the fibromas and the complexity of the anatomy. Patients were followed up at 6, 12 and 24 months after treatment. The primary endpoint was improvement in pain and/or function from baseline, defined as a patient-reported decrease in pain and/or increased ability to perform daily tasks previously limited by the fibromatosis. Any report of “improvement”, “less pain”, or “increased activity” was considered a positive response, obtained during structured follow-up interviews. A secondary endpoint was the formation of new fibromas, and whether these occurred inside or outside the radiotherapy field.

Results:

A total of 36 patients were reviewed (18 palmar, 17 plantar, 1 both). Median age was 60 years (range 30-74), and 11 (31%) had positive family history. At baseline, 26 (72%) reported pain, and 23 (64%) reported functional impairment. Median follow-up was 12 months (range, 0.1-55), with five being lost to follow-up.

At 6-month follow-up, 20/23 (87%) reported improvement in pain or function, including 83% of palmar and 90% of plantar disease. At 12 months, improvement was maintained in 16/18 (89%).

New fibromas developed in 5/23 (23%) patients, occurring within and outside the RT field in 1 and in 4 cases respectively. There was no significant difference in new fibroma development between plantar and palmar disease (p = 0.3). Toxicity was limited to early G1 skin erythema, G1 paraesthesia and G2 skin dryness, in 4/23 patients (17%).

Conclusion: RT for extremity fibromatosis was well tolerated and associated with meaningful symptom and functional improvement. Our findings support the use of primary RT in early-stage DD and symptomatic LD in accordance with the RCR guidelines.