Postoperative Electron-Beam Irradiation Therapy for Keloids and Hypertrophic Scars: Retrospective Study of 147 Cases Followed for More Than 18 Months

Abstract

Between 1988 and 2000, 378 cases of keloids were treated in the authors' department, and 147 keloids in 129 patients were selected for this study. Keloids that occurred at a different site in the same patient and keloids that recurred later at the same site were deemed to be different keloids. Those keloids were surgically removed, and the patients were treated postoperatively with 15-Gy electron-beam irradiation and followed for more than 18 months. The therapeutic outcomes were evaluated. Statistical analysis was performed using Fisher's exact probability test or chi-square test. Recurrence occurred in two sites on 14 earlobes (14.3 percent), in two sites on 12 necks (16.7 percent), in 22 sites on 51 anterior chest walls (43.1 percent), in 13 sites in 33 scapular regions (39.4 percent), in four sites on 15 upper limbs (26.7 percent), in four sites in 11 suprapubic regions (36.4 percent), and in one site on 11 lower limbs (9.1 percent). The overall recurrence rate was 32.7 percent. Analysis of the therapeutic outcomes showed that the recurrence rates in the sites with high stretch tension, such as the chest wall, and the scapular and suprapubic regions were statistically higher than in sites without high tension, such as the neck, earlobes, and lower limbs (41.1 percent versus 13.5 percent, p = 0.0017). The results suggested that keloid sites with a high risk of recurrence should be treated with escalated radiation doses and posttreatment self-management.

Up-to-date approach to manage keloids and hypertrophic scars: A useful guide

“…There is a consensus that ionizing irradiation is an effective way to treat keloids [60]. Superficial X-rays, electron-beam therapy and brachytherapy have been used with good results in scar reduction protocols, primarily as adjuncts to surgical removal of keloids [61].…”

“…Radiotherapy (brachytherapy as first line followed by electron-beam therapy [62]) is the most efficacious treatment available in severe cases of keloids, combined with surgical excision [6,35]. Its main disadvantage is the malignancy risk as possible but rare side effect [1,20,46,60,63]. …”

Reconstitution of Human Keloids in Mouse Skin

“…Surgical excision or steroid injection can be effective in the short term, but the keloid often recurs. There is less recurrence when adjuvant radiotherapy is conducted after surgical excision of the keloid, 3 although the application of radiotherapy to a benign tumor is controversial.…”

Current progress in understanding the molecular pathogenesis of burn scar contracture

“…Hypertrophic scars frequently occur at particular sites, including the anterior chest wall, auricle, scapula, and suprapubic regions, which are frequently subjected to the high stretch tension from the natural daily movements of the body [43]. The activity of myofibroblasts depends on the mechanical microenvironment.…”