Radiation Therapy for Early-Stage Dupuytren’s Disease
Clinical experience and published insights from Michael J. Yunes, MD
A summary of patient selection, evidence, treatment technique, and the CT-based workflow described in Dr. Yunes’ 2025 Practical Radiation Oncology publication and Adaptiiv webinar.
PUBLISHED CLINICAL EXPERIENCE
Dr. Michael J. Yunes reports a clinical workflow built around early referral, documentation, and reproducible setup.
In his 2025 Practical Radiation Oncology publication, Dr. Yunes describes a CT-based workflow for treating Dupuytren’s disease with RT at UMass Chan Medical School–Baystate. The approach uses Adaptiiv 3D Bolus software to create custom 3D-printed modulated bolus, supporting reproducible setup where conventional sheet bolus can be difficult to position consistently.
For additional clinical context, Dr. Yunes’ article in Practical Radiation Oncology is available here.
CLINICAL STARTING POINT
Start with disease stage, activity, and treatment intent.
RT is intended to act on active fibroproliferative tissue before fixed deformity. It should not be presented as a corrective treatment for established contracture.
Disease phase
Early, clinically active, and demonstrably progressing disease.
Typical presentation
Palpable nodules or cords with little or no fixed flexion deformity.
Treatment intent
Stabilize or slow progression—not release a cord or reverse a contracture.
Clinical considerations
Document progression, use a reproducible treatment setup, and monitor change over time.
PATIENT SELECTION
In his 2025 clinical discussion, Michael J. Yunes, MD, recommends clear evidence of progression before definitive RT. In that institutional approach, contractures greater than 10 degrees—described as Tubiana stage I or higher—are generally excluded outside a clinical trial unless a patient declines an invasive procedure and understands that RT will not improve the deformity.
When progression is not already documented, serial photographs and measurements can be used to establish change over time.
Ways to Document Baseline & Change
Clinical photographs and diagrams of nodules and cords
Hand-grip strength
Southampton Dupuytren’s Score
Measurement of flexion deformity
Finger-span and finger-raise measurements
Patient symptoms, function, and timing of change
Published Discussion of the Evidence
The evidence supports a careful discussion—not a guarantee.
In his 2025 article, Yunes summarizes stability or improvement in approximately 80–90% of selected patients reported in published series. Those results are clinically relevant, but they come mainly from observational, single-group evidence and must be interpreted against an unpredictable natural history
Reported experience
Long-term series describe stabilization, regression, symptom relief, and high patient satisfaction in many patients treated during early disease.
What is still being studied
Randomized evidence remains limited, and additional prospective research is ongoing.
Published Tips for Treating Dupuytren's with RT
Published Treatment Parameters
WHY THE HAND IS DIFFERENT
The hand makes bolus contact a treatment-planning problem.
The palmar surface is curved and irregular, target depth can vary across the field, and fingers create narrow spaces where sheet bolus may lift from the skin. Over a fractionated course, small differences in contact and placement can become a reproducibility problem.
Common Problems When Treating the Hand with RT
Conformity
Flat or hand-formed material may leave air gaps around curves and between digits.
Daily alignment
Opaque material can obscure skin markings and make repeatable placement harder to confirm.
Variable depth
A uniform 1 cm layer may not reflect the depth needed across the full target.
A patient-specific bolus designed to the shape of your hand.
The hand is a difficult area to fit: it is curved, irregular, and full of small spaces where a flat sheet can lift away from the skin.
TrueFit – Clear Bolus is a rigid, transparent, patient-matched device designed from imaging data in Adaptiiv 3D Bolus software. It is made for one patient and can be used throughout that patient’s treatment course.
Benefits of Using 3D-Printed TrueFit-Clear Bolus
Rigid transparent resin | Approximate density 1.20 g/cc | Minimum thickness 3 mm
TrueFit Bolus received FDA 510(k) clearance under K260308 for use as a prescription accessory during external beam radiation therapy for cancer or other non-malignant tissue conditions for which radiation therapy is indicated. The device is designed from patient imaging data and must be verified and approved by a trained radiation therapy professional before use
REPORTED INSTITUTIONAL EXPERIENCE
What the published Adaptiiv-enabled workflow reported.
Dr. Yunes reports that custom, in-house 3D-printed modulated bolus was introduced in 2022 to reduce gaps, standardize treatment, and support accurate dosimetry. The printed bolus ranged from 0.4 to 1.0 cm in thickness in the described cohort, reflecting variation in treatment depth.
Optically stimulated luminescent dosimeters used for the first 10 patients confirmed dose within 1–2% at the skin surface.
Published CT images show the custom bolus in contact with the skin without a visible air gap in the illustrated case.
The author reports that the material and immobilization improved daily setup time and patient comfort in the institutional workflow.