Escarmant P, Zimmermann S, Amar A, Ratoanina J L, Moris A, Azaloux H, Francois H, Gosserez O, Michel M, G'Baguidi R
Department of Radiation Oncology, Clarac Hospital, France.
Int J Radiat Oncol Biol Phys. 1993 May 20;26(2):245-51. doi: 10.1016/0360-3016(93)90204-9.
the aim of this study is to confirm the effectiveness of irradiation associated with surgery in the treatment of keloids, to precise the factors favoring the recurrence of these keloids, and to evaluate the risk of recurrence, according to their initial distinctive features.
between 1977 and 1988, 544 patients, with a total of 855 keloids, were treated by interstitial radiotherapy immediately following total excision.
recurrence rate is 21%, as against 50 to 80% for surgery alone, according to most authors. This recurrence rate is about the same as for external radiotherapy, but we prefer our method for practical reasons (cost, equipment, radiobiology, technique). Ninety percent of recurrences occurred in the year following therapy, which proves that a follow-up time of at least 12 months is needed for a study of keloids. In our experience, the keloids that are the most likely to recur are the largest and those giving rise to most symptoms. Bruising and loosened stitches, but in particular infection during therapy, largely favor a recurrence. In our series, the symptoms disappeared or were much improved in 80% of cases, and the cosmetic result was judged good by 75% of the patients.
the results of this study proves the effectiveness of the method linking surgical excision and Iridium 192 interstitial irradiation and shows the importance of the sterile conditions of the treatment.
本研究旨在证实手术联合放疗治疗瘢痕疙瘩的有效性，明确促使这些瘢痕疙瘩复发的因素，并根据其初始特征评估复发风险。
1977年至1988年间，544例患者共855个瘢痕疙瘩在完全切除后立即接受组织间放疗。
复发率为21%，而多数作者认为单纯手术的复发率为50%至80%。该复发率与外照射放疗相近，但出于实际原因（成本、设备、放射生物学、技术），我们更倾向于采用我们的方法。90%的复发发生在治疗后的一年内，这证明对瘢痕疙瘩的研究至少需要12个月的随访时间。根据我们的经验，最易复发的瘢痕疙瘩是最大的以及产生症状最多的。瘀伤和缝线松动，但尤其是治疗期间的感染，在很大程度上会促使复发。在我们的系列研究中，80%的病例症状消失或明显改善，75%的患者对美容效果评价良好。
本研究结果证明了手术切除与铱192组织间照射相结合方法的有效性，并显示了治疗无菌条件的重要性。
