Radiotherapy for Symptomatic Knuckle Pads Associated With Dupuytren's Disease: A Report of a Case Series

Knuckle pads are often diagnosed in patients with palmar fibromatosis or Dupuytren's disease. At present, no widely accepted treatment for knuckle pads has been established. Here, we describe the outcomes of patients with knuckle pads treated with radiotherapy at our institution.

Patients who had received radiotherapy for knuckle pads since 2012 and completed questionnaires at the time of consultation and at follow-up interview are included in this longitudinal analysis. We report patient characteristics, treatment plans, patient-reported knuckle pad response to radiotherapy, and patient satisfaction.

Nine Caucasian patients, median age 56 years old (range, 42-63), including seven women and two men, completed radiotherapy to their knuckle pads. Eight patients received simultaneous radiotherapy to the palms, and two patients additionally received radiotherapy to the soles. The time since treatment varied from 3 to 12 years, with a median duration of nine years. Typical treatment included a split-course prescription to 30 Gy in 10 daily fractions with a 6-12-week mid-treatment break. Electron beam energy was typically 6 MeV prescribed to the 90%-100% isodose line using a 1-1.5 cm bolus. Following radiotherapy, seven out of nine (78%) patients reported either resolution, flattening of knuckle pads, or stable disease. One patient (11%) reported resolution of knuckle pads in one hand, but enlargement and the development of new knuckle pads in the other hand. One patient (11%) reported worsening disease with enlargement of knuckle pads wrapping around the fingers toward the palmar aspect. Regarding symptomatic treatment response, eight patients (89%) reported improved symptoms or symptom resolution since radiotherapy including improvement in tenderness and pain, one (11%) reported stable symptoms. Minimal acute and chronic toxicity was reported. Eight patients (89%) reported favorable outcomes.

Our study details the treatment response of nine patients with knuckle pads to radiotherapy. Patients tolerated treatment well, with the majority reporting symptomatic and physical improvement, as well as favorable satisfaction with outcomes. Our findings suggest that radiotherapy is a safe and effective treatment option for knuckle pads providing durable disease control and can be considered in the appropriate clinical setting.