Radiotherapy found to be effective in 89% of patients with Garrod's pads
Radiotherapy found to be effective in 89% of patients with Garrod's pads
The IORBC welcomes a new case series into radiotherapy for symptomatic knuckle pads associated with Dupuytren’s disease — we highlight it here for the attention of hand surgeons and radiation oncologists.
Garrod’s pads have been treated with radiotherapy by members of the IORBC board for many years; it is rewarding to see this first publication reflecting work we routinely perform.
In the case series, the authors report on their institutional experience on radiotherapy for symptomatic knuckle pads in patients with palmar or plantar fibromatosis — with patient-reported outcomes of symptomatic response, change in knuckle pad size, and overall satisfaction with treatment outcome described.
As noted, ‘knuckle pads, or Garrod’s nodes, are areas of benign subcutaneous fibromas overlying the extensor side of fingers and toes, most often involving the proximal interphalangeal joints.’ (Garrod's pads are also called dorsal Dupuytren's nodules). At present, no widely accepted treatment for knuckle pads has been established — hence the potential for radiotherapy as an effective treatment option.
The analysis examined nine Caucasian patients, with a median age of 56 years old (range, 42-63) — including seven women and two men. 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:
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
The results were promising 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 patient (11%) reported stable symptoms. Minimal acute and chronic toxicity was reported
Eight patients (89%) reported favourable outcomes
The findings suggest that radiotherapy is a safe and effective treatment option for knuckle pads — a welcome result — with patients tolerating treatment well, with the majority reporting symptomatic and physical improvement, as well as favourable satisfaction with outcomes.
A note in reflection of the text:
Dr. Richard Shaffer, President of the IORBC, uses a slightly different scheme of treatment that allows some patients to only need one phase of treatment. We have illustrated this below:
- 15Gy in 5#
- Review at 3 months
- Consider a further 15Gy in 5#
Access the full text at the link below:
Citation:
Stark A, Sharifzadeh Y, Kahn J, et al. (June 11, 2025) Radiotherapy for Symptomatic Knuckle Pads Associated With Dupuytren’s Disease: A Report of a Case Series. Cureus 17(6): e85796. doi:10.7759/cureus.85796