A Novel Radiotherapy Approach for Keloids with Intrabeam

Abstract

Background. Keloids are hard nodules or plaques formed by excessive proliferation of connective tissue. Radiotherapy, widely used in various benign and malignant skin diseases, is an effective treatment for keloids. This work evaluates Intrabeam photon radiotherapy in the management of keloids. Methods. Fourteen patients who have undergone Intrabeam radiotherapy for a total of 15 sites of keloids were followed up. Twelve cases were first onset and the other two had recurrent diseases. Thirteen patients underwent surgical resection of keloids before radiotherapy. One relapsing patient received only 2 rounds of radiation therapy as she could not be reoperated. Radiotherapy was divided into 2 sessions on days 0 and 3 after surgery. The dose was 4 or 5 Gy each time for 3 min 14 s to 12 min 1 s. In addition, we compared our data to the recurrence of keloids in fourteen patients who had previously been exposed to electron beam using conventional accelerators. Results. We analyzed the treatment for adverse reactions and recurrence. In the Intrabeam group, one patient developed superficial skin ulcers a month after treatment. No one experienced wound rupture, bleeding, infection, skin contractures, or obvious hyperpigmentation. None of the fourteen cases showed any recurrence so far after on median 22.5 months of follow-up. Five patients in the electron beam group relapsed 3 to 10 months after treatment. Conclusion. Here, Intrabeam photon radiotherapy was shown to be an effective treatment for keloid scars and it is therefore recommended for management of this disease.

A Review of Current Keloid Management: Mainstay Monotherapies and Emerging Approaches

“…Although the study size was limited and there may have been a degree of confounding due to the adjunct use of platelet-rich plasma and a proprietary topical cream, the results are nonetheless promising [ 56 ]. Recent work comparing electron beam radiation to low-energy photon radiotherapy found significantly fewer recurrences in the low-energy photon radiotherapy group, which supports previously discussed work [ 57 ]. In summary, years of data largely support radiation as an integral component in prevention of postoperative keloid recurrence.…”

Efficacy of surgical excision and adjuvant high-dose rate brachytherapy in treatment of keloid: Our experience

“…[ 41 ] Newly laid unstable collagen is also sensitive to radiotherapy. [ 42 ] This results in a balance between the normal and abnormal collagen, thus preventing the development of keloid. In our study also first dose of brachytherapy was given within 24 h. The low recurrence rate in our study can be explained because of these factors also.…”

Controlling Inflammation Pre-Emptively or at the Time of Cutaneous Injury Optimises Outcome of Skin Scarring

“…A number of anti-inflammatory treatments for skin scarring have been evaluated for existing scars including radiotherapy, compression (pressure therapy), laser and 5-fluorouracil therapy ( 40 – 43 ). These therapies have been thought to supress inflammation by inhibiting angiogenesis as inflammatory cells migrate through blood ( 5 ).…”

“…Priming is defined as a substance that prepares the skin for use. Priming the skin prior to an invasive intervention for achieving an optimal result has been studied ( 34 – 40 ). However, the concept of pre-emptively priming the skin prior to injury has not been thoroughly evaluated.…”