I searched on the Medline database
to see if there have been reports in the medical literature that might
provide some answers to your query. I found many more reports about
Dupuytrens disease than about plantar fibromatosis.
Here follows a list of articles of potential relevance, together with
my own summary and/or extracts from the authors summaries. The URLs
lead to the Medline entry for the article with authors summaries.
With respect to DUPUYTRENS DISEASE:
Steroid treatment has been reported to reduce the rate of fibroblast
cell proliferation and increase the rate of apoptosis (programmed cell
death) in nodules of Dupuytren's disease. Fibroblasts are the cells
making up the fibrous tissue of the nodules. The treatment also
increased the rate of apoptosis of inflammatory cells in the nodules:
J Hand Surg [Br]. 2002 Jun;27(3):270-3.
The effect of steroids on Dupuytren's disease: role of programmed cell
D Meek RM, McLellan S, Reilly J, Crossan JF.
University Department of Orthopaedics, Western Infirmary, Glasgow,
Another report of promising results with steroid treatment:
J Hand Surg [Am]. 2000 Nov;25(6):1157-62.
The injection of nodules of Dupuytren's disease with triamcinolone
Ketchum LD, Donahue TK.
Department of Surgery, Menorah Medical Center, Overland Park, KS, USA.
Over a 4-year period 63 patients (75 hands) with Dupuytren's nodules
were treated with a series of injections with the steroid
triamcinolone acetonide directly into the area of disease
. After an
average of 3.2 injections per nodule 97% of the hands showed
regression of disease as exhibited by a softening or flattening of the
nodule(s). Although some patients had complete resolution of the
nodules, most experienced definite but incomplete resolution of the
nodules in the range of 60% to 80%. Although a few patients did not
experience recurrence or reactivation of the disease in the injected
nodules or development of new nodules, 50% of patients did experience
reactivation of disease in the nodules 1 to 3 years after the last
injection, necessitating 1 or more injections.
Radiotherapy has been reported to prevent disease progression in
Strahlenther Onkol. 2001 Nov;177(11):604-10.
[Radiotherapy of early stage Dupuytren disease. Long-term results
after a median follow-up period of 10 years]
[Article in German]
Adamietz B, Keilholz L, Grunert J, Sauer R.
Klinik und Poliklinik fur Strahlentherapie der Universitat
Between 1982 and 1994, 99 patients (176 hands) received orthovoltage
. The long-term outcome was analyzed at last follow-up
between July and November 1999. The median follow-up was 10 years
(range 7-18 years)
In Stage N 84% and Stage N/I 67% of cases remained
stable. 65% of the cases in Stage I and 83% in Stage II showed
progressive nodules and cords. In case of progression we saw no
complications after a second radiotherapy or salvage operation.
CONCLUSION: Radiotherapy effectively prevents disease progression for
early stage Dupuytren's contracture (Stage N, N/I). Moreover, in case
of disease progression despite radiotherapy salvage surgery is still
and also (the abstract to this paper defines the classification of
disease stage that is also used in the above reference):
Int J Radiat Oncol Biol Phys. 2001 Mar 1;49(3):785-98.
Radiotherapy optimization in early-stage Dupuytren's contracture:
first results of a randomized clinical study.
Seegenschmiedt MH, Olschewski T, Guntrum F.
Department of Radiation Oncology, Therapeutic Radiology and Nuclear
Medicine, Alfried Krupp Krankenhaus, Alfried Krupp Str. 21, 45117
Herein, the 1-year results of a prospective randomized trial are
presented which compared two different RT dose concepts with each
other. METHODS: 129 patients (67 males; 62 females) were entered in
this study: 69 had bilateral and 60 uni-lateral involvement of DC
accounting for 198 irradiated hands. According to Tubiana's
classification, 73 hands had Stage N (nodules/cords, no extension
deficit = flexion deformity), 61 had Stage N/I (< or = 10 degrees
deficit), 59 had Stage I (11-45 degrees deficit), and 5 had Stage II
(46-90 degrees deficit) DC
. Both prophylactic RT concepts have been
well accepted and tolerated by patients. Within the first year, they
were equally effective to prevent further disease progression of DC
and obtain considerable symptomatic improvement. Although 1-year
results suggest similar response rates for both treatment groups,
long-term FU [follow-up] of > 5 years has to be awaited for final
assessment and recommendation of an optimized RT treatment schedule.
Tamoxifen was found to decrease the growth in culture of fibroblasts
from tissue affected by Dupuytrens disease and to also to decrease
the production of TGF (tumor growth factor) beta-2 by the fibroblasts.
TGF beta-2 is thought to play a key role in the progression of
Dupuytrens disease. Please note, however, that this was very much an
experimental in vitro study. However, tamoxifen is used in the
treatment of Peyronies Disease, although only to reduce pain:
Surg Res. 2002 Apr;103(2):146-52
Tamoxifen decreases fibroblast function and downregulates TGF(beta2)
in Dupuytren's affected palmar fascia.
Kuhn MA, Wang X, Payne WG, Ko F, Robson MC.
Department of Veterans Affairs Medical Center, Institute of Tissue
Regeneration, Repair, and Rehabilitation, Bay Pines, Florida 33744,
With respect to treatment of the contractures themselves, a clinical
trial with collagenase has shown encouraging results:
J Hand Surg [Am]. 2002 Sep;27(5):788-98.
Collagen as a clinical target: nonoperative treatment of Dupuytren's
Badalamente MA, Hurst LC, Hentz VR.
Department of Orthopaedics, State University of New York at Stony
Brook, Health Science Center, Stony Brook, NY 11794, USA.
In a series of controlled phase-2 clinical trials, excessive collagen
deposition in Dupuytren's disease has been targeted by a unique
nonoperative method using enzyme (Clostridial collagenase) injection
therapy to lyse and rupture finger cords causing metacarpophalangeal
and/or proximal interphalangeal joint contractures
. The results of
these studies indicate that nonoperative collagenase injection therapy
for Dupuytren's disease is both a safe and effective method of
treating this disorder in the majority of patients as an alternative
to surgical fasciectomy. Phase-3 efficacy trials are now being planned
to further develop and test this method under Food and Drug
Administration regulatory guidelines.
I looked on the National Library of Medicine database of current
trials. One US trial that is currently recruiting will investigate
the effect of collagenase, but only when used after surgery to deal
with residual disease:
Phase II Randomized Study of Collagenase in Patients With Residual
Type Dupuytren's Disease
With respect to PLANTAR FIBROMATOSIS, there were many fewer articles,
and no new ones about treatment strategies.
A 1998 study of fibromatoses at various sites mentions the possibility
of radiotherapy with or without surgery:
Int J Radiat Oncol Biol Phys. 1998 Feb 1;40(3):637-45.
Individualizing management of aggressive fibromatoses.
Spear MA, Jennings LC, Mankin HJ, Spiro IJ, Springfield DS, Gebhardt
MC, Rosenberg AE, Efird JT, Suit HD.
Department of Radiation Oncology, Massachusetts General Hospital,
Harvard University Medical School, Boston 02114, USA.
These results are consistent with those found in the relevant
literature. They support primary resection with negative margins when
feasible. Radiation is a highly effective alternative in situations
where surgery would result in major functional or cosmetic defects.
When negative surgical margins are not achieved in recurrent tumors,
radiation is recommended. Perioperative radiation should be considered
in other high-risk groups (recurrent disease, positive margins, and
plantar tumors in young patients).
Other relatively recent articles (last 10 years) that deal with
treatment refer to surgery, with one exception. However, this
exception reports the failure of steroid treatment to cause
improvement in a case which resulted in the formation of ulcers on the
skin as well as internal nodules:
Hautarzt. 2001 Mar;52(3):236-9.
[Plantar fibromatosis with marked cutaneous involvement]
[Article in German]
de Almeida HL Jr, Wolter M, Neugebauer MG, Neugebauer S.
Medizinische Fakultat der Bundesuniversitat Pelotas, Brasilien.
Intralesional therapy with corticosteroids did not reduce the
lesions. After surgical treatment, the lesions recurred.
A method using laser surgery is described as an alternative to
traditional incision methods:
Clin Podiatr Med Surg. 1992 Jul;9(3):617-32.
Carbon dioxide laser excision of benign pedal lesions.
The CO2 laser is a very important tool to remove benign pedal
lesions. It certainly is not the only method, but once the technique
is developed by the surgeon, it becomes easier to remove these lesions
and, consequently, the results become better
. This is also true with
fibromas because many types of fibromas would require suturing that
would create an inconvenience for the patient. With the use of the
laser, sutures are not required and the patients recover much faster.
In dealing with plantar fibromatosis, ganglionic cysts, and lipomas,
the convalescence is probably about the same with CO2 laser as with
conventional removal, especially when deep resection is necessary and
suturing of the skin is required. With plantar fibromata surgery, the
resultant long-term scarring is much less with the CO2 laser,
especially when followed up with the appropriate injectables.
MeSH does not have a separate index term for Plantar Fibromatosis,
classifying it under the more-general term fibroma. I used
fibroma as a MeSH term in a further search (details and rationale in
Search Strategy description below). I did this to see if there were
any other therapeutic approaches, other than those listed above, being
investigated for similar diseases.
One review mentions a number of therapeutic strategies that have been
tried in various related conditions, with respect to controlling
recurrence after surgery. Steroids (hormonal agents) are cited as
giving promising results, also interferon, NSAIDS (non-steroidal
anti-inflammatory drugs) and cytotoxic drugs, of the sort used in
cancer chemotherapy (obviously the resulting side effects would make
this a treatment only for the most serious cases). However, the
authors conclude that as yet insufficient studies have been done to
allow a proper evaluation of these approaches.
Ann Oncol. 2003 Feb;14(2):181-90.
The pharmacological treatment of aggressive fibromatosis: a systematic
Janinis J, Patriki M, Vini L, Aravantinos G, Whelan JS.
Social Security Organization Oncology Center, Kifissia, Greece
Despite the use of surgery and radiotherapy, 20-35% of patients with
aggressive fibromatosis (AF) will have local recurrence. The purpose
of this review was to collect and analyze all available information
regarding the role of non-cytotoxic and cytotoxic chemotherapy in AF
that has been accumulated over the past few decades
. Most commonly
used agents include hormonal agents, non-steroidal anti-inflammatory
drugs (NSAIDs), interferons and cytotoxics. The literature data
support the use of hormonal agents. Several questions, however, remain
unresolved, such as which is the most suitable endocrine manipulation
and what is the optimal dose and duration of treatment. NSAIDs and
interferons have demonstrated activity against AF either alone or in
combination with hormone therapy or chemotherapy but the precise
mechanism of action is still unknown. Finally, there is growing
evidence in the literature that chemotherapy is effective against AF
with almost one in two patients being likely to respond
the lack of sufficient patient numbers and randomized trials
compromises the validity of the reported results and mandates further
investigation with properly designed prospective studies including
larger patient numbers, with main end points to include not only tumor
response rate and survival but also quality-of-life issues.
There is currently a European clinical trial on the efficacy of
radiotherapy against aggressive fibromatosis at any site:
Radiation Therapy in Treating Patients With Aggressive Fibromatoses
Search strategy: I searched on the Medline database using the MeSH
indexing system to narrow down the search to therapeutic approaches:
Dupuytrens search: "Dupuytren's Contracture"[MAJR] AND ("Dupuytren's
Contracture/drug therapy"[MAJR] OR "Dupuytren's Contracture/prevention
and control"[MAJR] OR "Dupuytren's Contracture/therapy"[MAJR])
Plantar Fibromatosis search: MeSH does not have a separate index term
for this condition, classifying it under the more-general term
fibroma. I therefore searched simply on plantar fibromatosis,
anticipating that there would not be a large number of records to
review (there were 109 altogether).
I also searched with the MeSH term fibroma: ("Fibroma/drug
therapy"[MAJR] OR "Fibroma/prevention and control"[MAJR] OR
In addition, I searched http://clinicaltrials.gov for news of any
ongoing clinical trials.
Please do not hesistate to request clarification if any of the above