Jiang Ping, Geenen Matthias, Siebert Frank-André, Bertolini Julia, Poppe Bjoern, Luetzen Ulf, Dunst Juergen, Druecke Daniel
Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Reconstructive Surgery, Lubinus Clinic Kiel, Kiel, Germany.
Brachytherapy. 2018 May-Jun;17(3):597-600. doi: 10.1016/j.brachy.2017.12.002. Epub 2018 Jan 2.
Recurring keloids are a clinical challenge. Interdisciplinary treatments are required in most cases. Owing to the wide variety of concepts, the optimal treatment regime remains unclear. Our clinic established a protocol of perioperative interstitial high-dose-rate brachytherapy with three fractions of 6 Gy and achieved an excellent 2-year local control rate of 94% (In search of the optimal treatment of keloids: Report of a series and a review of the literature). This report is an update on our long-term results of prospective study. Twenty-nine patients were included with a median followup of 5 years.
From 2009 to 2015, 29 patients with 37 recurrent keloids were treated with perioperative interstitial high-dose-rate brachytherapy; 3 patients had been previously treated with adjuvant external beam radiotherapy and presented with recurrences in the pretreated area. Brachytherapy was given in three fractions with a single dose of 6 Gy in 5-mm tissue depth and covered the scar in total length. Followup visits were scheduled at 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. Therapeutic outcome was assessed in terms of recurrence, acute and late complications, and cosmetic results.
No procedure-related complications occurred. Improvement of keloid-related symptoms was noticed in all patients after treatment. After a median followup of 49.7 months (range: 7.9-91.9 months), three keloid recurrences and two hypertrophied scars were observed.
Our results suggest that brachytherapy may be advantageous in the management of high-risk keloids, even after failure of external beam radiotherapy and other treatment procedures. Our three-fraction treatment schedule reduces the treatment period to 2 days and is therefore convenient for the patients.
复发性瘢痕疙瘩是一个临床挑战。大多数情况下需要多学科治疗。由于治疗理念繁多，最佳治疗方案仍不明确。我们的诊所制定了一项围手术期组织间高剂量率近距离放疗方案，分三次给予6 Gy，2年局部控制率达到了出色的94%（寻找瘢痕疙瘩的最佳治疗方法：系列报告及文献综述）。本报告是我们前瞻性研究长期结果的更新。纳入了29例患者，中位随访时间为5年。
2009年至2015年，对29例患有37个复发性瘢痕疙瘩的患者进行了围手术期组织间高剂量率近距离放疗；3例患者先前接受过辅助外照射放疗，在先前治疗区域出现复发。近距离放疗分三次进行，单次剂量为6 Gy，在5毫米组织深度，覆盖瘢痕全长。随访安排在6周、3个月、6个月、1年，此后每年进行。根据复发情况、急性和晚期并发症以及美容效果评估治疗结果。
未发生与手术相关的并发症。所有患者治疗后瘢痕疙瘩相关症状均有改善。中位随访49.7个月（范围：7.9 - 91.9个月）后，观察到3例瘢痕疙瘩复发和2例肥厚性瘢痕。
我们的结果表明，即使在外照射放疗和其他治疗方法失败后，近距离放疗在高危瘢痕疙瘩的治疗中可能具有优势。我们的三次分割治疗方案将治疗周期缩短至2天，因此对患者来说很方便。
