Radiation therapy modalities for keloid management: A critical review

Liu, Elisa K.; Cohen, Richard F.; Chiu, Ernest S.

doi:10.1016/j.bjps.2022.04.099

Cited by 18 publications

(14 citation statements)

References 61 publications

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“…For small lesions, the preferred approaches include intra-lesional corticosteroids, silicone elastomer sheeting, cryotherapy, or pressure dressing [8,17]. However for resistant or recurrent lesions, extra-lesional surgical excision in combination with other treatments, especially adjuvant postoperative radiotherapy, is considered to be the most e cacious treatment, which reduces the relapse rate to below 10% and improves patient's convenience [1,12,13]. In our study, the 5-year local control rate was 73%, which was comparable with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrence after Keloid Surgery with Electron Radiotherapy

Liu

2023

Preprint

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Aim to investigate the local control effect of postoperative electron radiotherapy for keloid and new recurrence risk factors. We collected the clinical data of 82 patients with 129keloids from January 2015 to October 2019. There were 23 males (28%) and 59 females (72%). Median age was 32 years (18-67 years). There were 26 recurrences, and the 1-year, 3-year and 5-year local control rates were 93%, 81% and 73%, respectively. Univariate analysis showed that age (p=0.025), hypertension (p=0.035), scar shape (p<0.001), primary site (p=0.021), maximum diameter of the lesion (p<0.001), pain and itching symptoms (p=0.005), local tension (p=0.005), and infection (p<0.001) were independent influencing factors. Multivariate analysis showed that the maximum diameter (p<0.001), infection (p<0.001), interval time (p=0.023), and previous treatment (p=0.020) were independent influencing factors. Our results suggest that complete excision of keloid combined with electron radiotherapy is safe and effective, while additional triamcinolone has no significant benefit for local control. For keloids with a high risk of recurrence, more aggressive treatment should be chosen, and further prospective studies are needed to explore the optimal treatment.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrence after Keloid Surgery with Electron Radiotherapy

Liu

2023

Preprint

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“…(A) Process and prognosis of postoperative radiotherapy for keloids, (B) mechanism of X-ray and selection of dose and depth, (C) mechanism of electron radiation and selection of dose and depth, and (D) mechanism of brachytherapy and selection of dose and depth. Reproduced with permission from Journal of Plastic, Reconstructive & Aesthetic Surgery ( 19 ).…”

Section: Radiation Therapy Techniquesmentioning

confidence: 99%

“…And a survey showed that 78% of oncologic radiologists considered radiotherapy an acceptable treatment for keloids ( 17 ). Radiotherapy modalities used to treat keloids include x-ray therapy, electron beam therapy, and brachytherapy ( 18 , 19 ). This review summarizes the progress of research on different radiation modalities and treatment options in postoperative adjuvant radiotherapy for keloids.…”

Section: Introductionmentioning

confidence: 99%

Current advances in the selection of adjuvant radiotherapy regimens for keloid

et al. 2022

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Keloid is a common benign skin tumor in the outpatient department, and patients are often accompanied by itching and pain. Since the pathogenesis is unknown, the effect of single method treatment is unsatisfactory, and therefore the recurrence rate is high. Therefore, comprehensive treatment is mostly used in clinical treatment. Adjuvant radiotherapy is currently one of the most effective treatments for keloid. After long-term clinical practice, brachytherapy and electron beam radiotherapy has increasingly become the gold standard of treatment, because brachytherapy provides more focused radiation treatment to focal tissue to significantly reduce recurrence rate, and better preserve normal tissue. With the development of new radiotherapy techniques, more options for the treatment of keloid. Currently, adjuvant radiotherapy has been widely recognized, but there is no consensus on the optimal protocol for adjuvant radiotherapy for keloids. This review provides a review of published treatment options and new radiotherapy techniques for adjuvant radiotherapy of keloids and gives a comprehensive evaluation for clinical treatment.

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“…With the improvement of radiation therapy delivery modalities, there has been a resurgence in its use for nononcologic indications, including keloid management, with more than 1 modality available. 11,12 The clinical benefit of adding radiation postsurgery has been reported in the literature, yet no evaluation of providers' perspective on the matter has been conducted. Thus, in this study, we propose to capture the thoughts of radiation oncologists' use of radiation therapy in the context of keloid management, including both believed risks and outcomes.…”

mentioning

confidence: 99%

“…However, concerns regarding long-term toxicity have limited the widespread adoption of adjuvant radiotherapy. With the improvement of radiation therapy delivery modalities, there has been a resurgence in its use for nononcologic indications, including keloid management, with more than 1 modality available 11,12 …”

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confidence: 99%

The Role of Radiation Therapy in Adult and Pediatric Keloid Management

Laspro,

Onuh,

Cohen

et al. 2023

Ann Plast Surg

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Introduction Radiation therapy is a promising modality for treating keloids after surgical excision. However, it is currently not standard practice among physicians because of concern surrounding the risk of radiation-induced secondary cancers, especially among pediatric patients. There is minimal research assessing the complications for radiation therapy in keloid management. Aim The goal of this study was to determine radiation oncologists' perspectives about the utility and appropriateness of radiation therapy for keloid management in both adult and pediatric patients. This study also aimed to characterize radiation modality, dose, fractionation, and secondary complications observed by providers. Methods An electronic survey was delivered to 3102 members of the American Society for Radiation Oncology. The survey subjects were radiation oncologists who are currently practicing in the United States. Rates of responses were analyzed. Results A total of 114 responses from practicing radiation oncologists were received. Of these, 113 providers (99.1%) supported radiation therapy for keloid management in adults, whereas only 54.9% supported radiation therapy for pediatric patients. Of 101 providers that treated adults in the past year, the majority used external beam: electrons (84.2%), applied 3 fraction regimens (54.4%), and delivered radiation within 24 hours postexcision (45.5%). In pediatric patients, only 42 providers reported treating at least 1 patient. The majority used electron beam radiation (76.2%), applied 3 faction regimens (65%), and delivered radiation on the same day of keloid excision (50.0%) The main concern when treating pediatric patients were risk of secondary malignancy (92.1%). Conclusion Although radiation therapy appears to be a widely accepted adjuvant treatment option for adults with keloids, the use of radiation therapy for pediatric patients is less widely accepted because of concerns regarding secondary malignancy. The findings suggest additional studies need to be carried out to assess the risk of those complications.

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Radiation therapy modalities for keloid management: A critical review

Cited by 18 publications

References 61 publications

Risk Factors for Recurrence after Keloid Surgery with Electron Radiotherapy

Risk Factors for Recurrence after Keloid Surgery with Electron Radiotherapy

Current advances in the selection of adjuvant radiotherapy regimens for keloid

The Role of Radiation Therapy in Adult and Pediatric Keloid Management

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