Treatment of Keloids with Excision and Postoperative X-Ray Irradiation

Abstract

During a 9-year period 47 patients with 62 keloids, treated with excision and postoperative superficial X-ray irradiation, were included in a retrospective study. The follow-up time was 6 months to 9 years. 88% experienced a good or excellent result. Single or fractioned dose and time interval between excision and radiation did not influence the result. Hyperpigmentation was noted as a side effect in 16 of 47 patients. More favorable results were obtained in the treatment of small keloids and of keloids located in the head-neck area compared to those on the trunk and the extremities.

Hypofractionated Electron-Beam Radiation Therapy for Keloids: Retrospective Study of 568 Cases With 834 lesions

“…Therefore, early intervention with radiotherapy should be the best timing for the treatment of keloids. Studies have reported that the threshold dose should be 12-14 Gy in a single fraction for reliable control by X-rays in a postoperative setting, and that radiotherapy should be given immediately after excision [7,[17][18][19]. Enhamre and Hammar [7] observed no association between treatment outcomes and the time interval between excision and radiation.…”

“…Studies have reported that the threshold dose should be 12-14 Gy in a single fraction for reliable control by X-rays in a postoperative setting, and that radiotherapy should be given immediately after excision [7,[17][18][19]. Enhamre and Hammar [7] observed no association between treatment outcomes and the time interval between excision and radiation. Sakamoto et al [20] stated that the time interval from operation did not affect the local control and adverse effects after radiotherapy.…”

“…The evaluation standards were proposed by Enhamre and Hammar [7] and by Veen and Kal [8]. The responses to treatment were classified into four levels: Level I (Good), no visible scar or small scar in the plane of the skin, no complaints, and no recurrence during follow-up; Level II (Improved), no itching or other complaints, visible scar partly elevated by no more than 1 mm above the plane of the skin, slight dehiscence, and no recurrence during follow-up; Level III (Invalid), scar remained and was accompanied by swelling and itching symptoms after treatment, within 3 months; and Level IV (Relapse), treatment was effective for 3 months, but scar became elevated above the plane of the skin, or scar dehiscence and itching and erythema symptoms appeared again, all after 3 months.…”

<b>Irradiation and Postangioplasty Restenosis</b>

“…6,7) Low dose external radiation is currently used for a number of different problems including the prevention of keloid formation after surgery and recurrence of pterygium after surgical removal. [8][9][10][11] Restenosis may be considered as a type of exuberant wound healing. The formation of new intraluminal tissue and the subsequent overall vessel constriction are similar to scar formation and contraction that occurs during the healing process after injury.…”

“…Histopathological evidence as revealed by autopsy studies shows the responses of human coronary arteries to angioplasty are a form of vessel wall stretch and dissection injury with subsequent scarring in the form of a proliferative neointima rich in extracellular matrix, similar to scars in other tissues. [12][13][14][15][16] This safe and effective use of radiation therapy for benign proliferative conditions has led a number of investigators to test whether local irra-diation might affect restenosis. This review is focused on the potential clinical application of endovascular brachytherapy for restenosis prevention.…”