PDF(Pubmed)
Abstract：
BACKGROUND: Postoperative radiotherapy can significantly reduce keloid recurrence. However, consensus on the optimal radiotherapy dose and treatment schedule remains elusive. This study aims to evaluate the effectiveness of surgery followed by a short-course of radiotherapy administered every other day for keloid treatment.
METHODS: We conducted a retrospective analysis of 498 patients with keloids treated at our institution between January 2010 and December 2017. All patients underwent electron beam irradiation at a dose of 16 Gy, delivered in four fractions every other day, starting within 24 h post-surgery. The primary endpoint of the study was the local control rate.
RESULTS: A total of 130 (26.5%) keloids recurred after a median follow-up of 68.1months (42.6-129.9 months). The local control rates at 1 year, 3 years and 5 years for all patients were 89.5%, 82.5% and 81%, respectively. The highest recurrence rate was observed in keloids located in the chest region (50.8%), followed by the suprapubic (47.8%), head and neck (38.8%), limbs (33.3%) and ear (14%). Both multivariate and univariate analyses identified the presence of pain and or pruritus as an independently prognostic factor for keloid recurrence (p<0.0001). The local control rates at 1-year, 3-years and 5-years for patients with or without symptom of pain or pruritus were 45% vs. 98.8%, 12.5% vs. 95.9%, and 8.8% vs. 95%, respectively (HR:37.829, 95%CI: 24.385-58.686, p<0.001). In the ear keloid subgroup, the 1-year, 3-year and 5-year local control rates for patients with pruritus were significantly lower than those without pain or pruritus (60.0% vs. 97.9%, 26.7% vs. 94.7%, 26.7% vs. 94.3%, HR:30.209, 95% CI:14.793-61.69, p<0.001). The same results were found in other location(p<0.001). During treatment and follow-up, two patients experienced infections, and one patient developed a cutaneous fibroblastoma.
CONCLUSIONS: This study suggests that a combination of surgery followed by short-course, every-other-day radiotherapy can yield satisfactory local control rates for keloids. Pain and or pruritus symptom was an independently prognostic factors for recurrence of keloid. To further validate these results, a prospective randomized controlled trial is recommended.
METHODS: We conducted a retrospective analysis of 498 patients with keloids treated at our institution between January 2010 and December 2017. All patients underwent electron beam irradiation at a dose of 16 Gy, delivered in four fractions every other day, starting within 24 h post-surgery. The primary endpoint of the study was the local control rate.
RESULTS: A total of 130 (26.5%) keloids recurred after a median follow-up of 68.1months (42.6-129.9 months). The local control rates at 1 year, 3 years and 5 years for all patients were 89.5%, 82.5% and 81%, respectively. The highest recurrence rate was observed in keloids located in the chest region (50.8%), followed by the suprapubic (47.8%), head and neck (38.8%), limbs (33.3%) and ear (14%). Both multivariate and univariate analyses identified the presence of pain and or pruritus as an independently prognostic factor for keloid recurrence (p<0.0001). The local control rates at 1-year, 3-years and 5-years for patients with or without symptom of pain or pruritus were 45% vs. 98.8%, 12.5% vs. 95.9%, and 8.8% vs. 95%, respectively (HR:37.829, 95%CI: 24.385-58.686, p<0.001). In the ear keloid subgroup, the 1-year, 3-year and 5-year local control rates for patients with pruritus were significantly lower than those without pain or pruritus (60.0% vs. 97.9%, 26.7% vs. 94.7%, 26.7% vs. 94.3%, HR:30.209, 95% CI:14.793-61.69, p<0.001). The same results were found in other location(p<0.001). During treatment and follow-up, two patients experienced infections, and one patient developed a cutaneous fibroblastoma.
CONCLUSIONS: This study suggests that a combination of surgery followed by short-course, every-other-day radiotherapy can yield satisfactory local control rates for keloids. Pain and or pruritus symptom was an independently prognostic factors for recurrence of keloid. To further validate these results, a prospective randomized controlled trial is recommended.
摘要：
背景：术后放疗可显著减少瘢痕疙瘩复发。然而,关于最佳放疗剂量和治疗方案的共识仍然难以捉摸.这项研究旨在评估手术的有效性，然后每隔一天进行一次短期放射治疗以治疗瘢痕疙瘩。
方法：我们对2010年1月至2017年12月在我院接受治疗的498例瘢痕疙瘩患者进行了回顾性分析。所有患者均接受16Gy剂量的电子束照射，每隔一天分四次交付，术后24小时内开始。研究的主要终点是局部控制率。
结果：中位随访68.1个月（42.6-129.9个月）后，共有130例（26.5％）瘢痕疙瘩复发。1年的地方控制率，3年和5年的患者均为89.5%,82.5%和81%,分别。在位于胸部区域的瘢痕疙瘩中观察到最高的复发率(50.8%),其次是耻骨上(47.8%)，头颈部（38.8%），四肢(33.3%)和耳朵(14%)。多变量和单变量分析都将疼痛和/或瘙痒的存在确定为瘢痕疙瘩复发的独立预后因素(p<0.0001)。1年的地方控制率，有或没有疼痛或瘙痒症状的患者的3年和5年分别为45％和98.8%,12.5%与95.9%,和8.8%vs.95%,分别（HR：37.829，95CI：24.385-58.686，p<0.001）。在耳朵瘢痕疙瘩亚组中，1年,瘙痒患者的3年和5年局部控制率显着低于无疼痛或瘙痒患者（60.0％vs.97.9%,26.7%vs.94.7%,26.7%vs.94.3%,HR：30.209，95%CI：14.793-61.69，p<0.001）。在其他位置发现了相同的结果(p<0.001)。在治疗和随访期间，两名患者经历了感染，一名患者发展为皮肤成纤维细胞瘤。
结论：这项研究表明，联合手术后短期手术，每隔一天的放疗可以获得令人满意的瘢痕疙瘩局部控制率。疼痛和/或瘙痒症状是瘢痕疙瘩复发的独立预后因素。为了进一步验证这些结果，建议进行前瞻性随机对照试验.
方法：我们对2010年1月至2017年12月在我院接受治疗的498例瘢痕疙瘩患者进行了回顾性分析。所有患者均接受16Gy剂量的电子束照射，每隔一天分四次交付，术后24小时内开始。研究的主要终点是局部控制率。
结果：中位随访68.1个月（42.6-129.9个月）后，共有130例（26.5％）瘢痕疙瘩复发。1年的地方控制率，3年和5年的患者均为89.5%,82.5%和81%,分别。在位于胸部区域的瘢痕疙瘩中观察到最高的复发率(50.8%),其次是耻骨上(47.8%)，头颈部（38.8%），四肢(33.3%)和耳朵(14%)。多变量和单变量分析都将疼痛和/或瘙痒的存在确定为瘢痕疙瘩复发的独立预后因素(p<0.0001)。1年的地方控制率，有或没有疼痛或瘙痒症状的患者的3年和5年分别为45％和98.8%,12.5%与95.9%,和8.8%vs.95%,分别（HR：37.829，95CI：24.385-58.686，p<0.001）。在耳朵瘢痕疙瘩亚组中，1年,瘙痒患者的3年和5年局部控制率显着低于无疼痛或瘙痒患者（60.0％vs.97.9%,26.7%vs.94.7%,26.7%vs.94.3%,HR：30.209，95%CI：14.793-61.69，p<0.001）。在其他位置发现了相同的结果(p<0.001)。在治疗和随访期间，两名患者经历了感染，一名患者发展为皮肤成纤维细胞瘤。
结论：这项研究表明，联合手术后短期手术，每隔一天的放疗可以获得令人满意的瘢痕疙瘩局部控制率。疼痛和/或瘙痒症状是瘢痕疙瘩复发的独立预后因素。为了进一步验证这些结果，建议进行前瞻性随机对照试验.
