Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Radiation Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 2018 Mar 1;100(3):679-686. doi: 10.1016/j.ijrobp.2017.10.044. Epub 2017 Nov 4.
To determine the optimal brachytherapy dose and fractionation scheme for keloid treatment.
Patient cohorts from 3 centers treated with keloid excision followed by 2 × 9 Gy, 3 × 6 Gy, or 2 × 6 Gy high-dose-rate brachytherapy were retrospectively compared regarding recurrence (after at least 12 months' follow-up) and complications (after at least 1 month's follow-up), using logistic regression analyses.
A total of 238 keloids were treated. An overall full recurrence rate of 8.3% was found. After correction for confounders (sex, skin color, keloid location, keloid duration) no statistically significant differences in recurrence rates could be discerned between fractionation schemes. There were 12.8% major and 45.6% minor complication rates. Lower radiation dose resulted in significantly fewer complications (odds ratio 0.35, P=.015).
After excision of resistant keloids, high-dose-rate brachytherapy with a biological equivalent dose of approximately 20 Gy is recommended, on the basis of low recurrence and complication rates.
确定治疗瘢痕疙瘩的最佳近距离放射治疗剂量和分割方案。
对 3 个中心的瘢痕疙瘩患者队列进行回顾性比较，这些患者在切除瘢痕疙瘩后接受了 2×9 Gy、3×6 Gy 或 2×6 Gy 高剂量率近距离放射治疗，比较其复发（至少 12 个月的随访后）和并发症（至少 1 个月的随访后），采用逻辑回归分析。
共治疗了 238 个瘢痕疙瘩。总的完全复发率为 8.3%。在对混杂因素（性别、肤色、瘢痕疙瘩位置、瘢痕疙瘩持续时间）进行校正后，在复发率方面，各分割方案之间没有统计学上的显著差异。主要并发症发生率为 12.8%，次要并发症发生率为 45.6%。较低的放射剂量显著减少了并发症的发生（比值比 0.35，P=.015）。
基于低复发率和低并发症发生率，建议在切除耐药性瘢痕疙瘩后，采用生物等效剂量约 20 Gy 的高剂量率近距离放射治疗。
