Jia Xiaojing, Ge Ying, Wang Hongyong, Ma Yan
Department of Radiation Oncology, The Second Hospital of Jilin University, Changchun, China.
Front Oncol. 2023 Jan 9;12:1032090. doi: 10.3389/fonc.2022.1032090. eCollection 2022.
Keratoacanthoma (KA) is a benign tumor that arises from the infundibulum of hair follicles. However, some researchers believe that KA is a subtype of squamous cell carcinoma (SCC) or a borderline tumor. There are two types of KA: single-type and multiple-type. Surgical resection is the first-line treatment for KA. The treatment options for patients with large lesions who are not surgical candidates are limited. We present a case of single-type KA patients with basic diseases and large lesions that were untreatable surgically, but the lesions essentially disappeared after radiotherapy. No recurrences were discovered during the two-year follow-up.
A 62-year-old male patient was admitted to the dermatology department of our hospital in June 2020 due to the discovery of a red papule on the right face two months prior, with occasional itching, which increased gradually. Pathological examination confirmed the diagnosis of KA. Due to the large lesions and underlying diseases, he was transferred to our radiotherapy department for radiotherapy after consultation. Since the surface of the lesion is uneven and close to the corner of the eye, we adopted intensity modulated radiation therapy (IMRT) at the beginning of radiotherapy. Following the reduction of the lesion, superficial electron beam and added a bolus with thickness of 5mm on the surface of the lesion was continued. The target dose: 42Gy/21 fractions (6MV X-ray, 22Gy; 2Gy/fraction; a total of 11 fractions, 6MeV electron beam, 20Gy; 2Gy/fraction; a total of 10 fractions). By the end of radiotherapy, the patient's facial tumor was dry and subsided. The facial tumor subsided significantly two years after radiotherapy, and the damaged skin on the face recovered to a flat shape.
The treatment experience of this case shows that IMRT combined with superficial electron beam radiotherapy may be an effective treatment for single-type KA patients with basic diseases and large lesions that are not suitable for surgery, and it is worth further study.
角化棘皮瘤（KA）是一种起源于毛囊漏斗部的良性肿瘤。然而，一些研究人员认为KA是鳞状细胞癌（SCC）的一种亚型或交界性肿瘤。KA有两种类型：单发型和多发型。手术切除是KA的一线治疗方法。对于有基础疾病且病变较大而不适合手术的患者，治疗选择有限。我们报告一例单发型KA患者，该患者有基础疾病且病变较大无法手术治疗，但放疗后病变基本消失。在两年的随访中未发现复发。
一名62岁男性患者于2020年6月因两个月前右侧面部发现红色丘疹入院，伴有偶尔瘙痒，且逐渐增大。病理检查确诊为KA。由于病变较大且有基础疾病，经会诊后转至我院放疗科进行放疗。由于病变表面不平且靠近眼角，放疗开始时我们采用了调强放射治疗（IMRT）。随着病变缩小，继续采用浅表电子束放疗，并在病变表面添加厚度为5mm的填充物。靶剂量：42Gy/21次分割（6MV X射线，22Gy；2Gy/次分割；共11次分割，6MeV电子束，20Gy；2Gy/次分割；共10次分割）。放疗结束时，患者面部肿瘤干燥消退。放疗两年后，面部肿瘤明显消退，面部受损皮肤恢复平整。
该病例的治疗经验表明，IMRT联合浅表电子束放疗可能是治疗有基础疾病且病变较大不适合手术的单发型KA患者的有效方法，值得进一步研究。
