Postoperative Radiation Protocol for Keloids and Hypertrophic Scars

Ogawa, Rei; Miyashita, Tetsuya; Hyakusoku, Hiko; Akaishi, Satoshi; Kuribayashi, Shigehiko; Tateno, Amane

doi:10.1097/sap.0b013e3180423b32

Cited by 126 publications

(72 citation statements)

References 14 publications

(16 reference statements)

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“…For example, the work of Ogawa [13] showed a recurrence rate of 29.3% using 15 Gy, which could be reduced to 14% when a larger total dose of 20 Gy was administered to certain lesions. Another study which supports the results obtained by Ogawa is that of Kuribayashi et al [14], who achieved a recurrence rate of 9.7% with brachytherapy using a total dose of up to 20 Gy.…”

Section: Discussionmentioning

confidence: 99%

Postoperative radiotherapy in the management of keloids

Carvajal¹,

Ibarra²,

Arbulo³

et al. 2016

ecancer

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BackgroundThe high recurrence rate following keloid resection has generated interest in adjuvant treatments for this disease.ObjectiveThis study assesses keloid recurrence when treated with surgery and adjuvant radiotherapy.MethodsRetrospective analysis of resected keloids in patients referred to a Chilean radiation oncology centre between 2006 and 2013. Local recurrence was defined as new tissue growth on the surgical scar margin.ResultsAround103 keloids were analysed in 63 patients treated with 15 Gy in three fraction radiotherapy which was initiated on the same day as the surgery (75% of cases). The median keloid diameter was 6 cm; the most common site was thoracic (22%); the most common cause was prior surgery (35%); 37% caused symptoms, and several (47%) had received prior treatment with corticosteroids (32%), or surgery (30%). The median follow-up was three years, and 94% of recurrences occurred during the first year following treatment. Uni and multivariate analyses showed that an absence of symptoms was a protective factor for recurrence (OR: 0.24), while the time interval from onset to treatment with surgery plus radiotherapy >4.2 years was a risk factor (OR: 2.23). The first year recurrence rate was 32% and stabilised at 32% by the second year with no recurrences after 15 months.ConclusionsThe combination of surgery and radiotherapy proved to be a good therapeutic alternative in the management of keloids. Our results are similar to those described in the literature for a dose of 15 Gy. Given these results, our centre will implement a new dose escalation protocol to improve future outcomes.

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Section: Discussionmentioning

confidence: 99%

Postoperative radiotherapy in the management of keloids

Carvajal¹,

Ibarra²,

Arbulo³

et al. 2016

ecancer

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“…4,5 After the sutures were removed, all wounds were covered with silicone-gel sheeting fixed with tape. Postoperative follow-up was performed approximately every 1–2 months.…”

Section: Methodsmentioning

confidence: 99%

“…However, surgical excision with postoperative radiation therapy is considered one of the most efficacious treatments. 1–5 Keloids spread as a “crab’s claw” and often take on a dumbbell form. Dumbbell-shaped keloids can usually be directly closed after excision; however, dispersion of mechanical force cannot be expected on the straight scar; therefore, there is a risk of keloid recurrence.…”

Section: Introductionmentioning

confidence: 99%

S-shaped Wound Closure Technique for Dumbbell-shaped Keloids

Komatsu

Azumi

Hayashi

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Summary:Dog-ear collection, Z-plasty, and W-plasty are often performed for excision of dumbbell-shaped keloids; however, these procedures require additional incisions or excision of normal skin. Thus, an S-shaped wound closure technique was performed. The keloid lesions were extralesionally excised above the deep fascia, and the wound edges were shifted in opposite directions along the major axis to form an S-shape. The incision was closed by applying deep fascial sutures, subcutaneous sutures, and superficial sutures. Postoperative external beam radiation therapy was started within 6 hours after surgery at a dose of 20 Gy applied in 4 fractions. All wounds were covered with silicone-gel sheeting and fixed with tape after suture removal. No intralesional corticosteroid injection or oral tranilast was administered. Corticosteroid tape was applied in cases with suspected postoperative recurrence. Scoring was performed using the Manchester Scar Scale. A total of 8 lesions were treated. Temporary erythema and scar elevation were observed in 2 chest lesions; however, both were flattened and turned white using corticosteroid tape. Other than these 2 lesions, there was no recurrence or complication. The mean score improved from 15.8 to 7.2. The S-shaped wound closure technique has 3 advantages. First, no additional incision or excision is required, and additional scarring and keloid recurrence can be avoided. Second, aesthetic results are good, and noticeably long and zigzag-shaped scars can be avoided. Third, dispersion of tension on the scar can be expected. Although the S-shaped wound closure technique has limited application, it is a useful option for keloid treatment.

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“…Although surgical excision is effective, high recurrence rates, ranging from 55% to 100%, can cause an even more severe situation in patients (Butler et al, 2008); however, as previously reported, postoperative electronic beam irradiation is one of the most effective treatments for the prevention of recurrent keloids (Ogawa et al, 2007; Stadelmann et al, 1998). …”

Section: Introductionmentioning

confidence: 96%

“…Keloid scarring, known as keloid disease, is an abnormal pathological scar that aggressively grows beyond the boundary of the original wound and invades surrounding healthy skin, which leads to itching, pain, and a stretching sensation (Ogawa et al, 2007; Shih and Bayat, 2010). Although surgical excision is effective, high recurrence rates, ranging from 55% to 100%, can cause an even more severe situation in patients (Butler et al, 2008); however, as previously reported, postoperative electronic beam irradiation is one of the most effective treatments for the prevention of recurrent keloids (Ogawa et al, 2007; Stadelmann et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Regulatory effects of electronic beam irradiation on mir-21/smad7-mediated collagen I synthesis in keloid-derived fibroblasts

Liu

Lei

et al. 2016

Biology Open

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Keloid scarring is an abnormal pathological scar characterized by excessive fibro proliferation and extracellular matrix deposition. Electronic beam irradiation is commonly used with surgical removal to control high recurrence rates of keloid scarring; however, the mechanism remains unknown. In this study, we used keloid-derived primary fibroblasts (KF) as the cell model, and a dose of 15 Gy energy, followed by quantitative PCR (qPCR), western blotting and gene overexpression/knock down techniques were used to reveal the molecular mechanisms affected by electronic beam irradiation. We found that mir-21 was highly expressed in KF and was downregulated by irradiation. We also showed that smad7 was a direct target of mir-21. Moreover, the expression level of smad7 was low in KF and upregulated by irradiation. We also found that smad7 controls Col-1 synthesis by mediating p38 phosphorylation, and this process was affected by electronic beam irradiation. The regulatory effect of electronic beam irradiation on the expression of mir-21, smad7, p38, p-p38 and Col-1 could be partly restored by mir-21 overexpression achieved by mir-21 mimic transfection. In conclusion, our data demonstrated that mir-21/smad7 regulated Col-1 expression in KF and that electronic beam irradiation was capable of decreasing Col-1 production by modifying mir-21/smad7-mediated p38 activation. This is the first report identifying the effects of electronic beam irradiation on miRNAs, providing a novel strategy to discover the molecular mechanisms of radiotherapy.

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Postoperative Radiation Protocol for Keloids and Hypertrophic Scars

Cited by 126 publications

References 14 publications

Postoperative radiotherapy in the management of keloids

Postoperative radiotherapy in the management of keloids

S-shaped Wound Closure Technique for Dumbbell-shaped Keloids

Regulatory effects of electronic beam irradiation on mir-21/smad7-mediated collagen I synthesis in keloid-derived fibroblasts

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