PDF(Pubmed)
Abstract：
BACKGROUND: Keloid is an abnormal proliferation of scar tissue that grows beyond the original margins of the injury. Even after complete resection, recurrences are common and pose a poorly understood challenge in dermatology. There is lack of large prospective clinical trials; thus, treatment recommendations are based on retrospective analyses and small cohort studies. Superficial radiotherapy is recommended in recurrent keloids; however, the successful treatment rates vary greatly. The aim of this study was to evaluate the keloid recurrence rate after post-excision soft X-ray radiotherapy and the associated factors.
METHODS: We reviewed retrospective data of all patients, treated with adjuvant post-excision soft X-ray radiotherapy with 12 Gy in 6 sessions at the tertiary referral center, Department of Dermatology, University Hospital Zurich, Switzerland, between 2005 and 2018. We analyzed individual keloids as separate cases. Successful treatment was defined as no sign of recurrence within 2 years.
RESULTS: Of the 200 identified patients, 90 met the inclusion criteria and were included in the final analysis. In 90 patients, 104 cases of treated keloids were analyzed. Keloids were mainly located on the trunk (49%) and were mostly caused by previous surgery (52.2%). 50% of the keloids did not relapse within 2 years after therapy. A significant factor leading to recurrence was the presence of previous therapy, with prior topical therapies, such as steroid injections or 5-fluorouracil, leading to most relapses. 69.2% of keloid cases who relapsed were pretreated. Soft X-ray radiotherapy was well tolerated, with posttreatment hyperpigmentation noted in 34% of patients, particularly in patients with non-Caucasian origin (61.3%).
CONCLUSIONS: Treatment of refractory keloids is difficult. Post-excision radiotherapy is an established adjuvant treatment option; nevertheless, recurrence rates are high, especially in pretreated keloids. Prospective studies determining the exact dosage and fraction of post-excisional radiotherapy are needed to determine the optimal radiation parameters.
METHODS: We reviewed retrospective data of all patients, treated with adjuvant post-excision soft X-ray radiotherapy with 12 Gy in 6 sessions at the tertiary referral center, Department of Dermatology, University Hospital Zurich, Switzerland, between 2005 and 2018. We analyzed individual keloids as separate cases. Successful treatment was defined as no sign of recurrence within 2 years.
RESULTS: Of the 200 identified patients, 90 met the inclusion criteria and were included in the final analysis. In 90 patients, 104 cases of treated keloids were analyzed. Keloids were mainly located on the trunk (49%) and were mostly caused by previous surgery (52.2%). 50% of the keloids did not relapse within 2 years after therapy. A significant factor leading to recurrence was the presence of previous therapy, with prior topical therapies, such as steroid injections or 5-fluorouracil, leading to most relapses. 69.2% of keloid cases who relapsed were pretreated. Soft X-ray radiotherapy was well tolerated, with posttreatment hyperpigmentation noted in 34% of patients, particularly in patients with non-Caucasian origin (61.3%).
CONCLUSIONS: Treatment of refractory keloids is difficult. Post-excision radiotherapy is an established adjuvant treatment option; nevertheless, recurrence rates are high, especially in pretreated keloids. Prospective studies determining the exact dosage and fraction of post-excisional radiotherapy are needed to determine the optimal radiation parameters.
摘要：
背景：瘢痕疙瘩是瘢痕组织的异常增生，其生长超出损伤的原始边缘。即使在完全切除后，复发是常见的,在皮肤病学中构成了一个鲜为人知的挑战.缺乏大型前瞻性临床试验，因此,治疗建议基于回顾性分析和小型队列研究.建议复发性瘢痕疙瘩进行表面放疗；然而，成功率差异很大。本研究的目的是评估切除术后软X射线放疗后瘢痕疙瘩的复发率及其相关因素。
方法：我们回顾了所有患者的回顾性资料，在三级转诊中心进行了6个疗程的辅助切除后软X线放射治疗，其中包括12个灰色，皮肤科,苏黎世大学医院,瑞士,2005年至2018年。我们将个体瘢痕疙瘩作为单独的病例进行了分析。成功的治疗被定义为在2年内没有复发的迹象。
结果：在确定的200名患者中，90例符合纳入标准，纳入最终分析。在90名患者中，对104例瘢痕疙瘩进行分析。瘢痕疙瘩主要位于躯干（49％），主要由先前的手术引起（52.2％）。50%的瘢痕疙瘩在治疗后2年内没有复发。导致复发的一个重要因素是先前治疗的存在，与先前的局部治疗，如类固醇注射或5FU，导致大多数复发。69.2％复发的瘢痕疙瘩病例经过预处理。软X线放疗耐受性良好，34%的患者注意到治疗后色素沉着过度，特别是非白种人患者（61.3％）。
结论：治疗难治性瘢痕疙瘩困难。切除后放疗是一种既定的辅助治疗选择，然而，复发率很高,尤其是预处理过的瘢痕疙瘩.需要进行前瞻性研究，以确定切除后放疗的确切剂量和分数，以确定最佳放射参数。
方法：我们回顾了所有患者的回顾性资料，在三级转诊中心进行了6个疗程的辅助切除后软X线放射治疗，其中包括12个灰色，皮肤科,苏黎世大学医院,瑞士,2005年至2018年。我们将个体瘢痕疙瘩作为单独的病例进行了分析。成功的治疗被定义为在2年内没有复发的迹象。
结果：在确定的200名患者中，90例符合纳入标准，纳入最终分析。在90名患者中，对104例瘢痕疙瘩进行分析。瘢痕疙瘩主要位于躯干（49％），主要由先前的手术引起（52.2％）。50%的瘢痕疙瘩在治疗后2年内没有复发。导致复发的一个重要因素是先前治疗的存在，与先前的局部治疗，如类固醇注射或5FU，导致大多数复发。69.2％复发的瘢痕疙瘩病例经过预处理。软X线放疗耐受性良好，34%的患者注意到治疗后色素沉着过度，特别是非白种人患者（61.3％）。
结论：治疗难治性瘢痕疙瘩困难。切除后放疗是一种既定的辅助治疗选择，然而，复发率很高,尤其是预处理过的瘢痕疙瘩.需要进行前瞻性研究，以确定切除后放疗的确切剂量和分数，以确定最佳放射参数。
