This article walks through the process step by step, so you know exactly what to expect from the consultation through to the treatment sessions themselves.
If you are considering radiotherapy for Dupuytren’s disease, then you may have some questions:
- What happens when I first come to the clinic?
- How long is it between the initial appointment and starting treatment?
- What actually happens during the treatment sessions?
- Will anything touch my hand?
- Will I feel anything during the treatment?
- Can I drive afterwards?
Before the consultation
Before attending the clinic, you will usually already have filled in a questionnaire about your Dupuytren’s disease and medical history.
You will also have received written information beforehand explaining how radiotherapy works, the benefits, and the possible side effects. Most patients, therefore, arrive already knowing the basics.
The consultation and planning appointment
The consultation itself is usually around 30 minutes. We talk through when you first noticed the disease, whether it has been changing, and what symptoms it is causing. I will then examine the hands carefully, assessing the nodules, cords, skin changes, and whether there is any loss of finger movement or flexibility.
I also examine the feet, because some patients with Dupuytren’s disease also develop related nodules in the soles of the feet, called Ledderhose disease.
If radiotherapy appears appropriate, we then discuss the likely benefits, limitations, and possible side effects.
The areas of disease are marked out on the hand, photographs are taken for the medical records, and the radiotherapy field is planned. You then sign a consent form if you decide to proceed.
Afterwards, you spend some time with the radiographers, who organise the practical side of treatment and gather the information needed to create the treatment setup.
The whole visit is normally around an hour altogether.
Why is there usually a wait before treatment starts?
Most patients start treatment around two to three weeks after the consultation.
This is because a custom metal shield has to be manufactured specifically for your hand. This fits into the treatment machine and shapes the radiation beam accurately around the treatment area.
What happens when you arrive for treatment?
The actual treatment appointments are usually very straightforward.
Most patients are surprised by how simple and calm the process feels once they have been through the first session.
Each appointment normally lasts around 10 minutes in total.
When you arrive, the radiographers bring you into the treatment room and ask you to lie down on the treatment couch. The couch is firm and flat, similar to what you might experience during a scan.
Your hand is then positioned carefully.
The most important part of the session is getting the hand into exactly the same position each day, so that the treatment is delivered accurately and consistently.
Sometimes a custom plastic mould is placed over the hand to help keep it still and in the same position each time. A wax-like material may also be placed over the treatment area. This helps bring the radiation dose towards the surface tissues where Dupuytren’s disease sits.
Nothing sharp, invasive, or painful happens during this process.
What does the treatment machine look like?
The treatment machine sits next to the couch and moves into position above the hand.
The machine does not clamp onto the hand or touch it.
Once everything is lined up correctly, the radiographers leave the room briefly and watch from just outside using cameras and monitors. This is standard for all radiotherapy treatments.
You are not left alone in the sense of being unmonitored. The radiographers can still see and hear you throughout the treatment.
What does the radiation feel like?
The radiation itself is completely invisible.
You do not see it, feel it, smell it, or hear it.
Most patients say that if they did not know the machine was switched on, they would not realise anything was happening.
There is no sensation of heat, burning, stinging, or electric shock.
The radiation beam is normally active for only around one or two minutes.
The rest of the appointment is mainly positioning the hand carefully and making sure everything is lined up accurately.
What happens after each session?
Once the treatment finishes, the radiographers come back into the room and help you sit up.
You can then simply get up and go home.
You are not radioactive afterwards, and there are no restrictions on being around other people, children, or pets.
Most patients drive themselves home and continue completely normal daily activities during the treatment course, including work, exercise, and using the hand normally.
Have questions about what to expect?
If you are weighing up radiotherapy for Dupuytren’s disease and want to talk through what the sessions involve, we are happy to help. Get in touch with Dr Shaffer to ask any questions or arrange a consultation.
How many treatments are there?
The standard treatment schedule is five treatments, usually given on consecutive weekdays.
If there is a weekend in the middle of the treatment week, that does not reduce the effectiveness of the treatment.
After the first five treatments, there is then a gap before the second phase of treatment. Traditionally, this gap is around three months, although in practice, there can be some flexibility depending on scheduling and travel arrangements.
The second phase is then another five treatments.
In total, patients therefore receive ten treatments altogether.
When do patients notice results?
One important thing to understand is that radiotherapy for Dupuytren’s disease is primarily a preventative treatment.
The main aim is to reduce the risk of the disease progressing further over time.
That means that if the nodules simply remain stable and the disease does not continue worsening, then radiotherapy may already have done its job successfully.
Some patients also notice additional changes such as reduced tenderness, softening of nodules, or partial shrinkage of the disease. However, these changes are more of a bonus rather than the main goal of treatment.
If improvements do occur, they often happen gradually. It can take up to a year after the end of radiotherapy to see the maximum effect.
Putting the whole process together
Once you have seen me in the clinic, there is normally a wait of around two to three weeks before treatment starts, while the treatment equipment is prepared.
The treatment itself is then usually around 10 minutes each day for five weekdays in a row.
After that, there is a gap of roughly three months before the second phase of treatment, which is another five treatments.
Patients are then generally followed up with a questionnaire around three months later. If you are considering treatment and would like to discuss your hand, you are welcome to get in touch.
