Objective:Radiation therapy combined with surgical excision was considered as one of the most effective treatment plans for keloid lesions. However, there was no unanimity found over present literatures regarding the issue on optimized treatment strategy for keloids. We here provide a comprehensive review over this issue and emphasize on the influencing factors.Data Sources:The data analyzed in this review were searched from articles included in PubMed and EMBASE databases.Study Selection:The original articles and critical reviews discussing the application of radiation therapy in keloids treatment were selected for this review.Results:The application of radiation therapy has transitioned from simple superficial X-ray irradiation to brachytherapy. Furthermore, several factors including radiation type, dose, fraction, interval, and complications were reviewed, and the results revealed that these factors were significant toward clinical outcome at various levels.Conclusions:Both past and present evidence support the idea that combination therapy of radiation and surgical therapy is safe and feasible. However, the optimization of treatment strategy was based on different radiation types and should take dose, fractions, interval, and complications into consideration, which will then decrease the rate of recurrence and increase the level of satisfaction.
Objective The popularity of contemporary microsurgical techniques in treatment of lower-limb lymphedema calls for better visualization of the lymphatic system, both preoperatively and intraoperatively. The aim of this prospective study was to investigate the feasibility of a novel combination of 68Ga-NEB PET with MR lymphography (MRL) in evaluating lymphedema and guiding surgical intervention. Methods A total of 11 patients (F 9, M 2, age range 29–69 y) with lower limb lymphedema classified into stage I to III were recruited. PET acquisition was performed at 30, 60, and 90 min after subcutaneous injection of the albumin-binding radiotracer 68Ga-NEB into the bilateral first web spaces of the feet. All the patients were also subjected to 99mTc-sulfur colloid (SC) lymphoscintigraphy for comparison. Gd-DTPA enhanced MRI was performed using sequences specialized for lymphatic vessel scans. All the patients underwent surgical interventions within a week. The surgical approach includes the use of linear marker for edema localization and ICG lymphography with near-infrared surgical navigation system intraoperatively. Results Lymph transport in lymphatic channels was clearly observed by visualization of 68Ga-NEB activity in the lymphatic vessels and within lymph nodes for all the 11 patients as well as the visualization of edema section plane with dermal backflow (DB), abnormally increased and disconnected uptake along the lymphatic channels. Preoperative 68Ga-NEB PET combined with MRL provides advantageous 3-dimensional images, higher temporal resolution, significantly shorter time lapse before image acquisition after tracer injection, more accurate pathological lymphatic vessel distribution than 99mTc-SC lymphoscintigraphy combined with MRI. Conclusion This study documented an effective imaging pattern to combine 68Ga-NEB PET and MRL in patients with lower-limb lymphedema. This strategy demonstrated significant advantage over 99mTc-SC lymphoscintigraphy/MRL in the evaluation of lymphedema severity, staging and pathological location of lymph vessels to make individualized treatment plan. Dual 68Ga-NEB PET/MRL is thus recommended before the operation for staging and therapy planning.
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