186 - Quality of Life and Toxicities Following Whole-Palm vs. Involved-Field Radiotherapy for Dupuytren's Disease: A Sub-Study from a Randomized Trial
Presenter(s)
R. Duvenage1, J. M. Martin2,3, T. Burgess4, B. McClelland4, D. Christie5, P. M. N. Werker6, W. Rozen7, R. J. H. M. Steenbakkers8, A. de Haan8, S. Anoora9, D. Sandoz10, J. Sappiatzer11, K. Neville12, S. Sampaio13, D. Schlect5, J. Bucci14, D. Hunter-Smith7, and D. Dilley15; 1GenesisCare, Newcastle, Australia, 2Calvary Hospital Newcastle, Newcastle, Australia, 3GenesisCare Gateshead, Newcastle, NSW, Australia, 4Hunter Hand Surgery, Newcastle, NSW, Australia, 5GenesisCare, Brisbane, QLD, Australia, 6Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 7Monash University, Melbourne, VIC, Australia, 8Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 9GenesisCare Research, Sydney, NSW, Australia, 10Hunter Hand Rehabilitation Centre, Newcastle, NSW, Australia, 11GenesisCare Adelaide, Adelaide, SA, Australia, 12GenesisCare Gateshead, Newcastle, Australia, 13GenesisCare Sydney, Sydney, NSW, Australia, 14GenesisCare Sydney, Sydney, Australia, 15Dilley Practice, Sydney, NSW, Australia
Purpose/Objective(s):
The Dupuytren’s Evaluation of Preventive or Adjuvant Radiation Therapy (DEPART) trial is comparing low-dose radiotherapy (LDRT) versus observation for contracture prevention in early Dupuytren’s disease. Guidelines vary regarding field selection due to concerns regarding toxicity from larger fields. Conversely, larger fields may allow for interobserver variability in disease detection, and better manage subclinical disease. Within the LDRT arm of the prevention group, treatment fields permitted were either whole-palm radiotherapy (WPRT) or involved-field radiotherapy (IFRT). This sub-study compares quality-of-life (QoL) and toxicity outcomes between WPRT and IFRT, with a hypothesis of any differences being minimal.Materials/Methods:
This sub-study analyzed 202 hands treated with LDRT (30 Gy in 10 fractions, split course) within the DEPART prevention cohort. Endpoints were three QoL tools, and eight toxicity criteria. QoL was assessed using the pain intensity visual analogue scale (VAS), Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH), and Unité Rhumatologique des Affections de la Main (URAM) at baseline, 6, 12, and 36 months. Toxicities were graded using CTCAE v4.03.Results:
Of 202 hands treated, 126 (62.4%) received WPRT and 76 (37.6%) received IFRT. Baseline characteristics were balanced between groups. 50% of the cohort had reached and completed 36 months of follow-up assessments. VAS Pain, QuickDASH and URAM scores were low across all tools and time points, improved between baseline and 36 months across all three tools, and did not differ significantly between groups at any time point. LDRT was well tolerated with no grade 3 or higher toxicity observed. Acute toxicity was low grade, expected (confined to only dermatitis, reduced sweating, fatigue and swelling), and more frequently reported following WPRT than IFRT. Persistent late effects were uncommon and confined to <5% incidence of low-grade reduced sweating in the WPRT cohort.Conclusion:
In early Dupuytren’s disease, LDRT delivered using either WPRT or IFRT was well tolerated and associated with comparable patient-reported outcomes through 36 months. Acute toxicity was expected, mild and more frequent following WPRT, while persistent late toxicity was infrequent, mild, and limited to a low rate of reduced sweating following WPRT. Pending definitive data on any efficacy benefits of LDRT in DD, expected in 2028, these findings support individualized field selection guided by disease distribution, clinical judgement and patient preference. The DEPART trial received Human Research Ethics Committee approval (2018-02-134-PVR-1) and has been prospectively registered (ACTRN12618000951257).