Thursday, 18 July 2013

Interview with Dr Herman, Radiotherapy specialist in Oklahoma

Today I have an interview with Dr Herman. He is a specialist that treats both plantar fibromatosis and Dupuytren's with radiotherapy. I came across his name through a patient that I interviewed, it seems that from the interview he is more helpful in person than over e-mail however he has still given some insight into the treatment that he performs. He is also good at responding to e-mails and I guess it is hard to know how much details to go into when being asked these questions by e-mail as anyone could be asking them.

Dr Herman is a radiation oncologist trained at Stanford and a medical oncologist trained at the University of Arizona. He spent 4yrs as faculty at Arizona, 7 years at Harvard, Dana-Farber, 11 years at San Antonio, University of Texas, 7 years at University of Oklahoma. To see his current location on a map please click here.

1) How long having you been treating Plantar fibroma's (PF) and where are you based?

Mostly it has been palmar, but both since my time in San Antonio, Texas, about 15 years. Where and who I am is in the information above.

2) Roughly how many PF patients have you treated? 

 Probably about 10 of the about total 60 patients have had plantar fibromatosis.



3) How common do you think PF is in the USA? It is supposedly more common in males then females and has been linked to a family history of PF and Dupuytren's,  smoking, alcohol consumption and diabetes are these risk factors you see in your patients? 

I could not say what the true incidence is, but, in my experience, the plantar patients present at a rate that is about 4 times less frequent than palmar patients. The factors you list are often touted as contributory, but I have not seen enough patients to gauge.


4) You treat with radiotherapy, what protocol do you use (dose, no of doses and gap between the treatment etc.) and what is the success rate on PF with radiotherapy? 

We use 300cGy fractions to a total of 2100cGY in 1 week, with two days being bid. My feeling is that, like palmar patients, control is achieved in over 90% of cases. (Note that this treatment  equates to have 7 lots of 3 gy, although this is different from most RT specialists  I have spoken to it is a known way of delivering the radiation to the lumps without having to do the second week, 2 days being bid means that they have double treatment that day with a 5 hours interval)


5) Why is radiotherapy a better course of action than other treatments such as surgery? 


Because the acute toxicities are minimal and I do not think it can make the condition worse as can surgery.

6) Generally speaking I have found that radiotherapy is not well known in the USA, why do you think this is?

The technique was developed in Germany, not here, and financial considerations come into play when private surgeons see patients and they often see these patients first. (And as I have seen from the other interviews I have done surgeons seem to be lacking in knowledge that RT exists, let alone that it is useful). 

7) Finally do you have any advice or other information that you would like to share with PF patients?


For radiation to work, patients must seek treatment before severe contracture is present, so do not procrastinate.