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Pract Radiat Oncol. 2015 Nov-Dec;5(6):e651-8. doi: 10.1016/j.prro.2015.06.010. Epub 2015 Jul 2.

Patient-reported outcomes after electron radiation treatment for early-stage palmar and plantar fibromatosis.

Author information

1
Department of Human Oncology, University of Wisconsin, Madison, Wisconsin; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia. Electronic address: jessica.moore84@hotmail.com.
2
Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
3
Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia.

Abstract

PURPOSE:

Palmar and plantar fibromatosis (PPF) is a progressive connective tissue disorder of the hand/foot that often leads to debilitating functional impairment. In Europe, orthovoltage radiation therapy (RT) has been demonstrated to prevent local disease progression for up to 80% of patients with early-stage PPF. There are limited data reporting outcomes for populations outside of Europe or using electron RT.

METHODS AND MATERIALS:

Between 2008 and 2013, 44 early-stage PPF cases received RT. RT fields involved clinically defined targets encompassing involved areas (skin changes, cords, nodules) with at least 1.5-cm margins. En face electrons (6-12 MeV) and bolus (0.5-1 cm) were selected individually. Outcomes are reported for patients who participated in an institutional review board-approved standardized questionnaire and chart review.

RESULTS:

Thirty-three patients received 66 treatments (45 hands/15 feet and 6 reirradiations). Most frequent dose schemes were 21 Gy (3 Gy in 7 fractions) and 30 Gy (3 Gy in 10 fractions with 6- to 8-week breaks after 15 Gy). Median time to follow-up survey was 31 months. Disease progression at any location within or outside the RT treatment field occurred in 20 of 33 patients (61%). Fourteen of 60 sites (23%) developed in-field progression, but 4 sites were successfully reirradiated with final local control in 50 of 60 sites (83%). RT improved pretreatment symptoms of pain with strain at 30 of 37 sites (81%) and itch/burn sensations at 17 of 21 sites (81%). There were no reported grade ≥2 late toxicities even with reirradiation. Patient reported overall success with treatment was 31 of 33 patients (94%).

CONCLUSION:

PPF is a progressive disease. En face electron RT is an effective therapy that stabilizes or improves symptoms in the majority of patients. Reirradiation can be considered as a treatment option for in-field progression. Patients report minimal toxicity and a high rate of satisfaction with treatment.

PMID:
26421835
DOI:
10.1016/j.prro.2015.06.010
[Indexed for MEDLINE]

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