难治性瘢痕疙瘩术后电子线照射客观临床结果及患者满意度研究

doi:10.3760/cma.j.cn113030-20210309-00093

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective Objective To investigate the role of radiotherapy in the treatment of refractory keloids, evaluate the self-assessment degree of satisfaction of patients and compare with the objective outcomes. Methods A total of 144 patients (290 lesions) with refractory keloids admitted to Peking Union Medical College Hospital from 2013 to 2018 were included in this study. The median age was 28 years old (range:15-81 years old).All lesions were subjected to electronic radiation at postoperative 24h. The regime of 5 to 7MeV electron beam radiation therapy was adopted. The total dose was ranged from 16 to 18Gy/2f (at 1-week interval). The median follow-up time was 48 months (range:35-91 months).Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the degree of satisfaction. Multivariate analysis was performed by Cox proportional hazards model. Results Among 290 keloids, 52keloids (17.9%) relapsed in 3 to 42 months from the end of radiotherapy (median 12 months). The main side effects were hyperpigmentation and local incisional extension. Univariate analysis showed that local incisional color darker than skin, pruritus, pain and young age were associated with recurrence. Multivariate analysis indicated that local incisional color darker than skin and pain were the independent prognostic factors for scar recurrence. Recurrence, hyperpigmentation and local incisional extension were the main reasons for patients' dissatisfaction. Conclusions Postoperative electronic radiation can achieve satisfactory efficacy in the treatment of refractory keloids. Local incisional color darker than skin and pain are the independent prognostic factors of keloid recurrence. Patient self-assessment results are not fully consistent with the objective clinical outcomes and recurrence status.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Sun Shuai
	Sun Xiansong
	Wang Yijun
	Zhang Yu
	He Lei
	Zhang Fuquan

Key words： Keloids/electron beam irradiation Treatment outcome Patient satisfaction

Received: 09 March 2021

Fund:National Key Research and Development Plan of Ministry of Science and Technology of the People's Republic of China (2016YFC0105207)

Corresponding Authors: Zhang Fuquan, Email:zhangfuquan3@126.com

Cite this article:

Sun Shuai,Sun Xiansong,Wang Yijun et al. Objective clinical outcome and patient satisfaction in self-assessment of postoperative electronic radiation for refractory keloids[J]. Chinese Journal of Radiation Oncology, 2021, 30(6): 582-586.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20210309-00093 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2021/V30/I6/582

[1] Al-Attar A, Mess S, Thomassen JM, et al. Keloid pathogenesis and treatment[J]. Plast Reconstr Surg, 2006, 117(1):286-300.DOI:10.1097/01.prs.0000195073.73580.46.
[2] Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management[J]. Plast Reconstr Surg, 2002, 110(2):560-571.DOI:10.1097/00006534-200208000-00031.
[3] Ogawa R, Yoshitatsu S, Yoshida K, et al. Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis[J]. Plast Reconstr Surg, 2009, 124(4):1196-1201.DOI:10.1097/PRS.0b013e3181b5a3ae.
[4] Shen J, Lian X, Sun Y, et al. Hypofractionated electron-beam radiation therapy for keloids:retrospective study of 568 cases with 834 lesions[J]. J Radiat Res, 2015, 56(5):811-817.DOI:10.1093/jrr/rrv031.
[5] 中国整形美容协会瘢痕医学分会常务委员会专家组. 中国瘢痕疙瘩临床治疗推荐指南[J]. 中国美容整形外科杂志,2018, 29(5):前插5-1-前插5-12. DOI:10.3969/j.issn.1673-7040.2018.05.001.
Group of Experts of the Standing Committee of the Scar Medicine Branch of the Chinese Society of Plastic and Beauty. Recommended guidelines for clinical treatment of keloid in China[J]. Chin J Aesth Plast Surg, 2018, 29(5):front 5-1 front 5-12. DOI:10.3969/j.issn.1673-7040.2018.05.001.
[6] Gangemi EN, Gregori D, Berchialla P, et al. Epidemiology and risk factors for pathologic scarring after burn wounds[J]. Arch Facial Plast Surg, 2008, 10(2):93-102. DOI:10.1001/archfaci.10.2.93.
[7] Ogawa R, Miyashita T, Hyakusoku H, et al. Postoperative radiation protocol for keloids and hypertrophic scars:statistical analysis of 370sites followed for over 18 months[J]. Ann Plast Surg,2007, 59(6):688-691.DOI:10.1097/SAP.0b013e3180423b32.
[8] Speranza G, Sultanem K, Muanza T. Descriptive study of patients receiving excision and radiotherapy for keloids[J]. Int J Radiat Oncol Biol Phys, 2008, 71(5):1465-1469. DOI:10.1016/j.ijrobp.2007.12.015.
[9] Zhang J, Miller C, O'malley V, et al. Patient and physician assessment of surgical scars:a systematic review[J]. JAMA Facial Plast Surg, 2018, 20(4):314-323.DOI:10.1001/jamafacial.2017.2314.
[10] 中国临床瘢痕防治专家共识制定小组. 中国临床瘢痕防治专家共识[J]. 中华损伤与修复杂志(电子版), 2017, 12(6):401-406.DOI:10.3877/cma.j.issn.1673-9450.2017.06.001.
China Clinical Scar Prevention Expert Consensus-making Group. Chinese expert consensus report on clinical prevention and treatment of scar[J]. Chin J Injury Repair Wound Healing (elec ed), 2017, 12(6):401-406.DOI:10.3877/cma.j.issn.1673-9450.2017.06.001.
[11] Bozkurt M, Ceran F, Guvercin E, et al. A new method for scar tissue assessment:modified POSAS observer scale[J]. Burns, 2017, 43(2):445-448. DOI:10.1016/j.burns.2016.04.022.
[12] Bae SH, Bae YC. Analysis of frequency of use of different scar assessment scales based on the scar condition and treatment method[J]. Arch Plast Surg,2014, 41(2):111-115. DOI:10.5999/aps.2014.41.2.111.
[13] Singer AJ, Arora B, Dagum A, et al. Development and validation of a novel scar evaluation scale[J]. Plast Reconstr Surg, 2007, 120(7):1892-1897.DOI:10.1097/01.prs.0000287275.15511.10.
[14] Tan A, Glass DA 2nd. Patient-reported outcomes for keloids:a systematic review[J]. G Ital Dermatol Venereol, 2019, 154(2):148-165. DOI:10.23736/S0392-0488.18.06089-3.
[15] Bischof M, Krempien R, Debus J, et al. Postoperative electron beam radiotherapy for keloids:objective findings and patient satisfaction in self-assessment[J]. Int J Dermatol, 2007, 46(9):971-975. DOI:10.1111/j.1365-4632.2007.03326.x.
[16] Hafkamp CJH, Lapid O, Dávila-Fajardo R, et al. Postoperative single-dose interstitial high-dose-rate brachytherapy in therapy-resistant keloids[J]. Brachytherapy, 2017, 16(2):415-420.DOI:10.1016/j.brachy.2016.12.009.
[17] Park TH, Seo SW, Kim JK, et al. Management of chest keloids[J]. J Cardiothorac Surg, 2011, 6:49. DOI:10.1186/1749-8090-6-49.
[18] Ojeh N, Bharatha A, Gaur U, et al. Keloids:current and emerging therapies[J]. Scars Burn Heal, 2020, 6:2059513120940499. DOI:10.1177/2059513120940499.
[19] Flickinger JC. A radiobiological analysis of multicenter data for postoperative keloid radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2011, 79(4):1164-1170.DOI:10.1016/j.ijrobp.2009.12.019.
[20] Mankowski P, Kanevsky J, Tomlinson J, et al. Optimizing radiotherapy for keloids:a meta-analysis systematic review comparing recurrence rates between different radiation modalities[J]. Ann Plast Surg, 2017, 78(4):403-411.DOI:10.1097/sap.0000000000000989.
[21] Song C, Wu H G, Chang H, et al. Adjuvant single-fraction radiotherapy is safe and effective for intractable keloids[J]. J Radiat Res, 2014, 55(5):912-916.DOI:10.1093/jrr/rru025.
[22] Taheri A, Molaei H, Aghili M, et al. Outcomes of surgical excision and brachytherapy in intractable keloids[J]. World J Plast Surg, 2017, 6(3):280-284.
[23] Fraunholz IB, Gerstenhauer A, Böttcher HD. Results of postoperative (90) Sr radiotherapy of keloids in view of patients' subjective assessment[J]. Strahlenther Onkol, 2005, 181(11):724-729. DOI:10.1007/s00066-005-1411-x.
[24] Arnault J, Peiffert D, Latarche C, et al. Keloids treated with postoperative Iridium 192* brachytherapy:a retrospective study[J]. J Eur Acad Dermatol Venereol, 2009, 23(7):807-813.DOI:10.1111/j.1468-3083.2009.03190.x.
[25] De Lorenzi F, Tielemans HJ, van der Hulst RR, et al. Is the treatment of keloid scars still a challenge in 2006?[J]. Ann Plast Surg, 2007, 58(2):186-192. DOI:10.1097/01.sap.0000237761.52586.f9.
[26] 孙帅,于浪,王贝,等. 两种放疗技术治疗难治性瘢痕疙瘩的剂量学比较[J]. 中国医疗设备,2020, 35(7):49-53.DOI:10.3969/j.issn.1674-1633.2020.07.012.
Sun S, Yu L, Wang B, et al. Dosimetric comparison of two kinds of radiotherapy techniques for intractable keloids[J]. Chin Med Dev, 2020, 35(7):49-53.DOI:10.3969/j.issn.1674-1633.2020.07.012.