Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Medical Faculty, University of Zurich, Zurich, Switzerland.
Dermatology. 2024;240(4):572-580. doi: 10.1159/000539782. Epub 2024 Jun 19.
Keloid is an abnormal proliferation of scar tissue that grows beyond the original margins of the injury. Even after complete resection, recurrences are common and pose a poorly understood challenge in dermatology. There is lack of large prospective clinical trials; thus, treatment recommendations are based on retrospective analyses and small cohort studies. Superficial radiotherapy is recommended in recurrent keloids; however, the successful treatment rates vary greatly. The aim of this study was to evaluate the keloid recurrence rate after post-excision soft X-ray radiotherapy and the associated factors.
We reviewed retrospective data of all patients, treated with adjuvant post-excision soft X-ray radiotherapy with 12 Gy in 6 sessions at the tertiary referral center, Department of Dermatology, University Hospital Zurich, Switzerland, between 2005 and 2018. We analyzed individual keloids as separate cases. Successful treatment was defined as no sign of recurrence within 2 years.
Of the 200 identified patients, 90 met the inclusion criteria and were included in the final analysis. In 90 patients, 104 cases of treated keloids were analyzed. Keloids were mainly located on the trunk (49%) and were mostly caused by previous surgery (52.2%). 50% of the keloids did not relapse within 2 years after therapy. A significant factor leading to recurrence was the presence of previous therapy, with prior topical therapies, such as steroid injections or 5-fluorouracil, leading to most relapses. 69.2% of keloid cases who relapsed were pretreated. Soft X-ray radiotherapy was well tolerated, with posttreatment hyperpigmentation noted in 34% of patients, particularly in patients with non-Caucasian origin (61.3%).
Treatment of refractory keloids is difficult. Post-excision radiotherapy is an established adjuvant treatment option; nevertheless, recurrence rates are high, especially in pretreated keloids. Prospective studies determining the exact dosage and fraction of post-excisional radiotherapy are needed to determine the optimal radiation parameters.
瘢痕疙瘩是一种异常的疤痕组织增生，超出了损伤的原始边缘。即使完全切除，复发也很常见，这是皮肤科面临的一个尚未完全了解的难题。目前缺乏大型前瞻性临床试验；因此，治疗建议基于回顾性分析和小队列研究。对于复发性瘢痕疙瘩，建议进行浅层放射治疗；然而，成功的治疗率差异很大。本研究旨在评估切除后软 X 射线放疗后瘢痕疙瘩的复发率及其相关因素。
我们回顾了瑞士苏黎世大学医院皮肤科三级转诊中心 2005 年至 2018 年间，接受辅助切除后软 X 射线放疗（12 Gy 分 6 次）的所有患者的回顾性数据。我们将单个瘢痕疙瘩作为单独的病例进行分析。成功治疗定义为 2 年内无复发迹象。
在 200 名确定的患者中，90 名符合纳入标准，并纳入最终分析。在 90 名患者中，分析了 104 例治疗的瘢痕疙瘩。瘢痕疙瘩主要位于躯干（49%），主要由既往手术引起（52.2%）。50%的瘢痕疙瘩在治疗后 2 年内没有复发。导致复发的一个显著因素是存在既往治疗，先前的局部治疗，如皮质类固醇注射或 5-氟尿嘧啶，导致大多数复发。69.2%复发的瘢痕疙瘩患者有预处理。软 X 射线放疗耐受性良好，34%的患者出现治疗后色素沉着，尤其是非高加索人种（61.3%）。
治疗难治性瘢痕疙瘩很困难。切除后放疗是一种已确立的辅助治疗选择；然而，复发率仍然很高，特别是在预处理过的瘢痕疙瘩中。需要前瞻性研究来确定确切的术后放疗剂量和分割剂量，以确定最佳的放射参数。
