Friday, 22 May 2015

International Dupuytren's Symposium - Day 1, morning

In Summary it was great to see so much interest and so much work going into these conditions, even if almost everything is focused on Dupuytren’s most of the work will have cross over with Ledderhose.

Note this is just an overview and I will try and go into more detail where possible.

The first session was really all about the different processes in different countries, mainly looking in USA, Germany and UK as this is where most of the patients are. There were some interesting points coming through on current trends and the increasing application of collagenase and gradual decrease in open surgery.

One point that interested me was that in the presentation Wolfgang gave it was clear that radiotherapy is actually a good treatment option for DD (as expected) in fact it was one of the top options. The next talk showed that patients, at least those that have had surgery, rank decreasing recurrence as their priority and I know this would probably be true for Ledderhose patient as well. Do these 2 observations combined mean that if you offered these patients the chance of radiotherapy at an early stage where recurrence would be low and their main other tissues such as side effects would be low surely they would take it?

The second session then moved onto a much more scientific point of view. Looking at the different markers in Dupuytren’s cells and how they can have an impact on the development and treatment of the conditions. I took a couple of main points from this:

  1. There is a clinical trial on using anti-TNF to treat the early stage of Dupuytren’s.
  2. I would like to follow up the above by contracting this person and seeing if they would be willing to expand the scope to include Ledderhose, certainly think we can get the patient numbers required.
  3. There is lots of interesting research being done and lots of discussion happening, patients should take some heart from this.
  4. DD cells can be problematic as they do not grow in normal culture environment in the same manner as other cells and this is an area which probably requires improvement and is being worked on.

There was lots of healthy debate in this session including:
  1. How to best control experiments, age groups etc and later onset of DD in control group.
  2. Does Estrogen play a role as some observed that this treatment increases odds - could this be linked to the later onset in women.
  3. Should science be looking more into the aggressive condition, these are the patients that are then more likely to go on and need treatment.

I think the final point is again interesting from a radiotherapy point of view, in that it is in these patients where perhaps RT is worth a go sooner rather than later, especially in cases of DD where the hand can only be treated before contracture has not yet started. Imagine if we could come up with a marker, yes you have high risk of LD / DD and you are showing symptoms and RT helps (assuming a study shows that radiotherapy is a / the most beneficial treatment option for these patients).

Certainly a fascinating and enjoyable start and a lot to be learnt. Time to build contacts over lunch and looking forward to more this afternoon.

I already have 7 pages of typed notes and sorry for any typo's as I am writing this on the go, hopefully I will have some pictures up and about for the post covering this afternoons sessions.