Pozzi Marcello, Zoccali Giovanni, Drago Maria C, Mirri Maria A, Costantini Maurizio, DE Vita Roy
Operative Unit of Plastic and Reconstructive Surgery, "Regina Elena" National Cancer Institute - IFO, Rome, Italy -
G Ital Dermatol Venereol. 2016 Oct;151(5):492-8. Epub 2015 Apr 24.
Despite the wide availability of literature on keloids, their onset is not completely understood. Several protocols have been described to treat keloids, but none are considered to be a gold standard. In this paper, we will report our experience treating recurrent keloids with surgical excision, followed by immediate postoperative radiotherapy, focusing on the irradiation protocol, to better define the treatment schedule, dose, and results.
From September 2009 to July 2012, 10 patients were referred to our department because of unresponsive keloids. All patients underwent 6-MeV electron beam radiotherapy, up to a total dose of 20 Gy, 24-48 hours after radical surgical keloid excision.
Three patients had excellent results, while 5 patients had good results and 2 had moderate results; none of the cases had poor results. No major adverse events were observed. Small keloids can be treated with non-surgical therapy or radical excision, although followed by an adjuvant therapy. Radiotherapy seems to be a better adjuvant approach. The mechanism for the radiotherapeutic prevention of keloids is still poorly understood. It may act by controlling collagen synthesis through the elimination of abnormally-activated fibroblasts.
From our results, postoperative electron radiotherapy is an effective and well-tolerated treatment to prevent keloid recurrence, especially in patients with bulky keloids or recurrent disease.
尽管有关瘢痕疙瘩的文献资料广泛可得，但其发病机制尚未完全明确。已有多种治疗瘢痕疙瘩的方案被描述，但尚无一种被视为金标准。在本文中，我们将报告我们采用手术切除后即刻进行术后放疗治疗复发性瘢痕疙瘩的经验，重点关注放疗方案，以更好地确定治疗时间表、剂量和结果。
2009年9月至2012年7月，10例因瘢痕疙瘩治疗效果不佳而转诊至我科的患者。所有患者在瘢痕疙瘩根治性手术切除后24 - 48小时接受6兆电子伏电子束放疗，总剂量达20戈瑞。
3例患者效果极佳，5例患者效果良好，2例患者效果中等；无一例效果差。未观察到重大不良事件。小的瘢痕疙瘩可采用非手术治疗或根治性切除，但随后需辅助治疗。放疗似乎是一种更好的辅助方法。放射治疗预防瘢痕疙瘩的机制仍了解甚少。它可能通过消除异常激活的成纤维细胞来控制胶原蛋白合成而起作用。
根据我们的结果，术后电子放疗是预防瘢痕疙瘩复发的一种有效且耐受性良好的治疗方法，尤其适用于瘢痕疙瘩较大或复发性疾病的患者。
