De Cicco Luigi, Vischioni Barbara, Vavassori Andrea, Gherardi Federica, Jereczek-Fossa Barbara Alicja, Lazzari Roberta, Cattani Federica, Comi Stefania, De Lorenzi Francesca, Martella Stefano, Orecchia Roberto
Division of Radiotherapy, Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Varese, Italy.
Division of Radiation Oncology and Radiobiology, National Center for Oncological Hadrontherapy CNAO, Pavia, Italy.
Brachytherapy. 2014 Sep-Oct;13(5):508-13. doi: 10.1016/j.brachy.2014.01.005. Epub 2014 Feb 17.
We report the experience of the Radiation Oncology Department of the European Institute of Oncology in Milan, Italy, on the adjuvant low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy. Brachytherapy might be useful to improve keloids recurrence rate or reduce keloids treatment side effects instead of external beam radiotherapy.
Data on 70 consecutive patients treated after complete keloid surgical excision were retrospectively analyzed. First 38 patients and 46 keloids were treated with adjuvant LDR brachytherapy and the following 39 patients and 50 keloids underwent HDR treatment. Median delivered dose of LDR therapy was 16 Gy; HDR median dose was 12 Gy. Sixty-four keloids (66.7%) were symptomatic at diagnosis with pain, itching, or stress.
Fourteen relapses over 46 treated keloids (30.4%) were observed in the LDR group and 19 of 50 keloids (38%) in the HDR group (p = 0.521). Recurrence rate was significantly higher in males (p = 0.009), in patients younger than 44 years (p < 0.0001), for arms, neck, and chest wall anatomic sites (p = 0.0001) and for symptomatic keloids (p = 0.017). Aesthetic outcome was better in case of larger keloids (>8 cm) (p = 0.064). Symptomatic relief was achieved in 92% of HDR patients and only 68% of LDR patients (p = 0.032).
Postoperative brachytherapy is an effective treatment for keloids. In our study, LDR and HDR treatments resulted in similar recurrence rate. Better symptomatic relief was reported in case of HDR treatment compared with the LDR regimen.
我们报告了意大利米兰欧洲肿瘤研究所放射肿瘤学部门在辅助性低剂量率（LDR）和高剂量率（HDR）间质近距离放射治疗方面的经验。近距离放射治疗可能有助于提高瘢痕疙瘩的复发率或减少瘢痕疙瘩治疗的副作用，而非外照射放疗。
对70例瘢痕疙瘩完全手术切除后接受治疗的连续患者的数据进行回顾性分析。前38例患者和46个瘢痕疙瘩接受了辅助性LDR近距离放射治疗，随后的39例患者和50个瘢痕疙瘩接受了HDR治疗。LDR治疗的中位给予剂量为16 Gy；HDR中位剂量为12 Gy。64个瘢痕疙瘩（66.7%）在诊断时有疼痛、瘙痒或压痛等症状。
LDR组46个接受治疗的瘢痕疙瘩中有14个复发（30.4%），HDR组50个瘢痕疙瘩中有19个复发（38%）（p = 0.521）。男性的复发率显著更高（p = 0.009），44岁以下患者的复发率显著更高（p < 0.0001），手臂、颈部和胸壁等解剖部位的复发率显著更高（p = 0.0001），有症状的瘢痕疙瘩复发率显著更高（p = 0.017）。较大的瘢痕疙瘩（>8 cm）美学效果更好（p = 0.064）。92%的HDR患者症状得到缓解，而LDR患者中只有68%症状得到缓解（p = 0.032）。
术后近距离放射治疗是瘢痕疙瘩的有效治疗方法。在我们的研究中，LDR和HDR治疗导致的复发率相似。与LDR方案相比，HDR治疗报告的症状缓解效果更好。
