Abstract Purpose: Dosimetric comparison was performed of radiation methods for target coverage and non-target sparing in palmar fibrosis (i.e., Dupuytren disease). Most early stage disease has been treated with superficial radiation using standard cones and shielding of uninvolved areas. With clinical set up, no information regarding depth of the nodules or percent coverage of the target was obtained. With concern for late effects of radiation used to treat a benign condition and declining availability of superficial radiation equipment, we compared dosimetry of superficial radiation versus patient specific electron therapy. Methods: One female patient (thinner hand) and one male patient were selected for intra-patient range in a CT dosimetric comparison of 6-MeV electrons ± bolus versus 90kV photons. The clinically set up target volume (CTV) included cords/nodules plus 1-2 cm margin. The posterior hand avoidance was defined as the tissues posterior to the ventral border of the metacarpal bones. Results: Normalized to 90% of the prescribed dose, 6-MeV electrons ± bolus achieved 100% coverage of CTV. The dose maximum as well as dose to the posterior hand avoidance was reduced by bolus. The 90% isodose line with the superficial radiotherapy was 0.4 cm depth and achieved 73-75% CTV coverage. Conclusions: 6-MeV electrons with individualized bolus gave superior CTV coverage over superficial radiotherapy at the 90% isodose lines, with relative sparing of normal tissues.
Keywords: palmar fibrosis; Dupuytren’s contracture; radiation