Viani Gustavo A, Stefano Eduardo J, Afonso Sergio L, De Fendi Ligia I
Department of Radiation Oncology, Marilia Medicine School, São Paulo, Brazil.
Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1510-6. doi: 10.1016/j.ijrobp.2008.07.065. Epub 2008 Dec 26.
The aim of this study was to evaluate the results of keloidectomy and strontium 90 brachytherapy in the prevention of keloid recurrence following excision and to identify outcome and the prognostic factors that predict keloid recurrence after irradiation.
Data of 612 patients with 892 keloids treated between 1992 and 2006 were evaluated retrospectively. Brachytherapy was performed using a Sr-90Y surface applicator. Total dose was 20 Gy in 10 fractions.
With a median follow-up of 61 months, the overall recurrence-free response rate for all keloids was 87.6%. Multivariate analysis revealed the following prognostic factors for recurrence: keloid size > 5 cm (p < 0.0001), burn scars as the keloid etiology (p < 0.0001), and previous treatment (p < 0.0001). Outcome was not found to be significantly related to the interval between surgery and radiotherapy, sex, or age. Pruritus and skin reddening were the most common symptoms of keloids, but all signs and symptoms abated with time after treatment. Cosmetic results from the keloid treatment were considered good or excellent in 70.6% of the patients.
Our study findings show that excision plus Sr-90 brachytherapy is effective in the eradication of keloids. Sr-90 radiotherapy (20 Gy in 10 fractions) achieved a similar local control rate, as have higher doses per fraction in other series. It also resulted in a good cosmetic rate and relief of symptoms. Our data further suggest that the initiation of postoperative irradiation within hours of surgical excision is not important to therapeutic outcome.
本研究旨在评估瘢痕疙瘩切除术联合锶90近距离放射治疗预防切除术后瘢痕疙瘩复发的效果，并确定放射治疗后瘢痕疙瘩复发的结局及预测复发的预后因素。
回顾性评估1992年至2006年间治疗的612例患者892个瘢痕疙瘩的数据。使用锶-90钇表面敷贴器进行近距离放射治疗。总剂量为20 Gy，分10次给予。
中位随访61个月，所有瘢痕疙瘩的总体无复发生存率为87.6%。多因素分析显示复发的预后因素如下：瘢痕疙瘩大小>5 cm（p<0.0001）、瘢痕疙瘩病因是烧伤瘢痕（p<0.0001）以及既往治疗情况（p<0.0001）。未发现结局与手术和放疗间隔时间、性别或年龄有显著相关性。瘙痒和皮肤发红是瘢痕疙瘩最常见的症状，但治疗后所有体征和症状均随时间减轻。70.6%的患者瘢痕疙瘩治疗的美容效果被认为良好或极佳。
我们的研究结果表明，切除加锶90近距离放射治疗对根除瘢痕疙瘩有效。锶90放射治疗（20 Gy，分10次）达到了与其他系列中更高分次剂量相似的局部控制率。它还带来了良好的美容率和症状缓解。我们的数据进一步表明，手术切除后数小时内开始术后放疗对治疗结局并不重要。
