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

Abstract

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.

Risk Factors for Recurrence after Keloid Surgery with Electron Radiotherapy

“…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.…”

“…Patients who could not return for an in-hospital follow-up were contacted by phone to con rm the success of the keloid treatment. Follow-up visits were scheduled at 3 months, 6 months, 1 year, and every year thereafter, as follow-up visits should extend for at least 1 year after treatment to improve the validity of the outcome because the chance of recurrence is minimal after 1 year [2,12]. Statistical analysis was performed with the SPSS 19.0 software.…”

Optimizing surgical outcome of auricular keloid with a novel multimodal approach

“…Irradiation could restore a balance between collagen degradation and synthesis by affecting extracellular matrix gene expression 8 . The recurrence rates of postoperative radiotherapy (Table 5 ) 16 – 20 varied from 4% to 19%. Acute radiation-associated adverse events, including skin ulceration, delayed wound healing, and skin graft necrosis, as well as chronic complications including permanent color change and telangiectasia, were reported in these studies 16 – 21 .…”

“…The recurrence rates of postoperative radiotherapy (Table 5 ) 16 – 20 varied from 4% to 19%. Acute radiation-associated adverse events, including skin ulceration, delayed wound healing, and skin graft necrosis, as well as chronic complications including permanent color change and telangiectasia, were reported in these studies 16 – 21 . Radiation-based treatments for keloids consist of electrons, X-rays, and brachytherapy 22 .…”

Surgical Core Excision With Tongue Flap Closure in Combination With Electron Beam Radiotherapy in the Treatment of Ear Keloids

“…6 The earlobe is one of the most common body sites where keloid formation is observed. 7 The most common cause of ear keloid is ear piercing; however, rarely, it can be caused by acne, drainage of auricular hematomas, skin infection, insect bites, or burn injuries. [8][9][10][11] Risk factors include dark skin, hyperactivity of the pituitary gland, pregnancy, hormone imbalances, and puberty.…”