Optimizing Radiotherapy for Keloids

Mankowski, Peter; Kanevsky, Jonathan; Tomlinson, Jared; Dyachenko, Alina; Luc, Mario

doi:10.1097/sap.0000000000000989

Cited by 112 publications

(76 citation statements)

References 65 publications

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“…Kal et al [ 15 ] conducted a dose–response analysis of external-beam radiotherapy for keloids and recommended that the BED should be at least 30 Gy to achieve a recurrence rate of < 10%. Another meta-analysis and systematic review including 72 studies reviewed radiation-based treatments used for keloid management [ 18 ]. To achieve 90% control of keloid recurrence, they suggested a dose of more than 35 Gy for external-beam radiotherapy according to the dose–response curve.…”

Section: Discussionmentioning

confidence: 99%

“…Our present results indicated that similar local control rates could be reached with a BED less than 30 Gy using electron-beam radiotherapy. In regard to different radiation modalities, no statistically significant difference was found in terms of local control between brachytherapy and electron-beam irradiation [ 18 ]. However, calculations of the BED for different radiation modalities are diverse.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective study of immediate postoperative electron radiotherapy for therapy-resistant earlobe keloids

Yuan

2019

Arch Dermatol Res

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Keloid resection followed by adjuvant radiotherapy is the most efficacious treatment for keloids. However, for earlobe keloids, an optimal protocol for the total dose and fractions of adjuvant radiation has not yet been established. We retrospectively analyzed the efficacy and safety of immediate three-fraction electron radiotherapy after operation for resistant earlobe keloids. From 2011 to 2017, three-fraction electron radiotherapy with single dose of 5 Gy was given postoperatively to 23 patients with 30 keloids in our hospital. The first fraction of adjuvant radiotherapy was administered within 2 h of surgery, and the other two sessions were completed within the next day or two. Five (16.7%) primary keloids and 25 (83.3%) recurrent keloids were examined in this study. The primary endpoint was the local control rate, which was 86.7% after a median follow-up of 26 months (14–93 months). Secondary endpoints were acute and late procedure-related complications, and no severe complications were observed after combination therapy. Our results suggest that three-fraction electron radiotherapy after excision within 2 days of surgery is a safe and effective protocol for the prevention of earlobe keloid recurrence that can also improve patient compliance and comfort.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrospective study of immediate postoperative electron radiotherapy for therapy-resistant earlobe keloids

Yuan

2019

Arch Dermatol Res

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“…Currently, the external beam radiotherapy is widely used for post-operative treatment of keloids, but some studies favor brachytherapy rather than superficial X-rays or electron beams [ 6 , 9 ]. A meta-analysis systematic review [ 10 ] indicated that brachytherapy had a lower recurrence rate (15%) when compared to electron beam and X-ray therapy (23% and 23%, respectively) for keloids. Guix et al .…”

Section: Discussionmentioning

confidence: 99%

Image-guided high-dose-rate intracavitary brachytherapy technique for nasal keloid – a case report

Huang¹,

He²,

Zhao³

et al. 2018

jcb

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The aim of this study is to report an uncommon case of nasal keloid treated with adaptive image-guided high-dose-rate (HDR) intracavitary brachytherapy. A 34-year-old female presented with nasal keloid after facial trauma was treated with scar resection and HDR intracavitary brachytherapy with a customized eccentric applicator. The total dose was 21 Gy in 6 fractions. During 3 years of follow-up, there was no evidence of recurrence at the local site, and no complications. In conclusion, HDR intracavitary brachytherapy is an effective way to prevent the recurrence of nasal keloids post-surgery.

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“…One systematic review showed that post-excisional X-ray, electron beam and brachytherapy can reduce the rate of keloid recurrence to 15–23% [ 20 ] while another showed the recurrence rate of keloid scars could be <10–20% when surgery was combined with brachytherapy, electron beam therapy or X-ray therapy [ 21 ]. Both these reviews applied the linear-quadratic concept to normalize doses to a biologically effective dose (BED) to compare the different doses of radiation used.…”

Section: Introductionmentioning

confidence: 99%

Assessing keloid recurrence following surgical excision and radiation

et al. 2020

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Keloids are a fibroproliferative disorder that can result from a cutaneous injury to the reticular dermis. Recurrence rates as high as 100% have been reported following surgical excision alone. Consequently, a variety of post-surgical techniques have been employed to prevent keloid recurrence, including the use of radiation. Although numerous studies have shown post-excisional X-rays, electron beam, lasers and brachytherapy can reduce the rate of keloid recurrence, numerous inconsistencies, including a wide range of definitions for keloid recurrence, make it difficult to compare study outcomes. The review aims to examine the various means for defining keloid recurrence in clinical trials involving the use of radiation therapy. Searches of the Cochrane Library and PubMed were performed to identify the available information for post-surgical keloid recurrence following radiation therapy. Each identified study was reviewed for patient follow-up and criteria used to define keloid recurrence. The search results included clinical studies with external beam radiation, brachytherapy and superficial radiation therapy. Many studies did not include a definition of keloid recurrence, or defined recurrence only as the return of scar tissue. Other studies defined keloid recurrence based on patient self-assessment questionnaires, symptoms and scar elevation and changes in Kyoto Scar Scale, Japan Scar Workshop Scale and Vancouver Scar Scale scores. The results of this review indicate keloidectomy followed by radiation therapy provide satisfactory recurrence rates; however, clinical studies evaluating these treatments do not describe treatment outcomes or use different definitions of keloid recurrence. Consequently, recurrence rates vary widely, making comparisons across studies difficult. Keloid recurrence should be clearly defined using both objective and subjective measures.

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Optimizing Radiotherapy for Keloids

Abstract: The results of this study reinforce postoperative radiotherapy as effective management for keloids. Specifically, brachytherapy was the most effective of the currently used radiation modalities.

Cited by 112 publications

References 65 publications

Retrospective study of immediate postoperative electron radiotherapy for therapy-resistant earlobe keloids

Retrospective study of immediate postoperative electron radiotherapy for therapy-resistant earlobe keloids

Image-guided high-dose-rate intracavitary brachytherapy technique for nasal keloid – a case report

Assessing keloid recurrence following surgical excision and radiation

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