The radiation therapy in keloids treatment: a comprehensive review of pathomechanism, damage mechanisms and cellular response

Xu, Jing; Yang, Elan; Yu, Nanze; Wang, Youbin; Long, Xiao

doi:10.20517/2347-9264.2017.24

Cited by 4 publications

(11 citation statements)

References 23 publications

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“…Finally, different activity of fibroblasts from different body sites might affect keloid recurrence. Previous studies have shown that keloid fibroblast is more sensitive to inflammatory factors than normal skin fibroblast 13 . To find whether different activity of fibroblasts from different body sites exists, we compared cell survival of keloid fibroblasts from our patients with normal fibroblast by the MTT method after irradiation to culture medium, which showed higher survival rate for normal fibroblast.…”

Section: Discussionmentioning

confidence: 97%

“…Treatments for keloid include intralesional steroids and chemotherapy, compression therapy, cryotherapy, laser therapy, surgical intervention, and radiotherapy 1,4,13 . Intralesional steroid is often used, and usually requires a series of injections, resulting in 50% to 100% response rates and 9% to 50% recurrence rates; however, treatment can continue for several months and can be painful 1,13 .…”

mentioning

confidence: 99%

“…Later, cell migration and proliferation of keratinocytes and myofibroblasts are promoted that increase collagen synthesis and deposition, then extracellular matrix (ECM) accumulates below the dermis, ultimately forming a scar. 12 A previous study has shown that keloid-derived fibroblast has higher sensitivity for transforming growth factor β1, insulin-like growth factor 1, than do normal skin fibroblasts, 13 which might explain why keloid grows faster than normal skin tissue.…”

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confidence: 99%

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Lesion Site Is the Key Prognostic Factor for Keloid Patients Receiving Surgery With Adjuvant Radiotherapy

et al. 2022

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BackgroundKeloid is a benign tumor with high recurrence rate; accordingly, complete surgical excision with adjuvant radiotherapy is one of the most effective treatments. This study reviewed outcomes of keloid patients receiving surgery and adjuvant radiotherapy in Kaohsiung Medical University Hospital.Materials and MethodsAll patients received radiation dose with 15 Gy, with their first radiotherapy within 24 hours after surgical excision. The end points were recurrence rate and local recurrence-free interval (LRFI), defined clinically as palpable gross tumor over the treatment site and duration from the last day of radiotherapy to disease recurrence.ResultsFrom May 2017 to July 2020, 32 patients with 40 keloid lesions were included. The mean age for these patients was 37.6 years, and the median follow-up time was 15.3 months. The overall recurrence rate was 52.5%, and the median LRFI was 9.7 months. Recurrence rates for males and females were 46.7% and 56% (P = 0.567), respectively; for head and ear, chest, shoulder and upper extremities, and abdomen and back were 12.5%, 61.5%, 63.6%, and 62.5% (P = 0.093); for lesions over 20 cm2 and below 20 cm2 were 62.5% and 50% (P = 0.527); and for megavoltage electron beam and kilovoltage photon beam were 56.7% and 40% (P = 0.361), respectively. Patients were further classified into 2 groups by lesion sites, which showed lower recurrence rate (P = 0.011) and longer LRFI (P = 0.028) with lesions over the head and ear than other sites.ConclusionsWe found that lesion site might be a prognostic factor for keloid recurrence. Adjuvant radiation dose escalation for high-recurrence risk areas (other than the head and ear) might be required.

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Section: Discussionmentioning

confidence: 97%

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confidence: 99%

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confidence: 99%

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Lesion Site Is the Key Prognostic Factor for Keloid Patients Receiving Surgery With Adjuvant Radiotherapy

et al. 2022

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“…The use of radiotherapy to inhibit scar growth was first reported in 1906. 64 Electron beam (β-ray) irradiation is considered to be the optimal radiotherapy approach, as it has better dose distribution and safety than other radiotherapy modalities. 65 Current clinical recommendations state that the dose in each fraction should be >12 and <20 Gy to optimize the therapeutic effect while minimizing adverse effects.…”

Section: Discussion Of Findings and Relevant Literaturementioning

confidence: 99%

Vascular and Collagen Target: A Rational Approach to Hypertrophic Scar Management

Yuan

Upton

Leavesley

et al. 2023

Advances in Wound Care

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Hypertrophic scarring is a challenging issue for patients and clinicians. The prevalence of hypertrophic scarring can be up to 70% after burns, and patients suffer from pain, itching, and loss of joint mobility. To date, the exact mechanisms underlying hypertrophic scar formation are unclear, and clinical options remain limited. Recent Advances: Several studies have demonstrated that pathological scars are a type of hyperactive vascular response to wounding. Scar regression has been found to be accompanied by microvessel occlusion, which causes severe hypoxia, malnutrition, and endothelial dysfunction, suggesting the essential roles of microvessels in scar regression. Therefore, interventions that target the vasculature, such as intense pulsed light, pulsed dye lasers, vascular endothelial growth factor antibodies, and Endostar, represent potential treatments. In addition, the mass of scar-associated collagen is usually not considered by current treatments. However, collagen-targeted therapies such as fractional CO 2 laser and collagenase have shown promising outcomes in scar treatment. Critical Issues: Traditional modalities used in current clinical practice only partially target scar-associated microvessels or collagen. As a result, the effectiveness of current treatments is limited and is too often accompanied by undesirable side effects. The formation of scars in the early stage is mainly affected by microvessels, whereas the scars in later stages are mostly composed of residual collagen. Traditional therapies do not utilize specific targets for scars at different stages. Therefore, more precise treatment strategies are needed. Future Directions: Scars should be classified as either ''vascular-dominant'' or ''collagen-dominant'' before selecting a treatment. In this way, strategies that are vascular-targeted, collagen-targeted, or a combination thereof could be recommended to treat scars at different stages.

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“…But far and now, it has been reported that it may reduce the scar size by inhibition of reproduction of fibroblasts after surgery, modulating the humeral and cellular factors which stimulate the production of fibroblasts (Keeling et al 2015). In vitro, it has been shown to inhibit proliferation and induce senescence of keloidal fibroblasts by interrupting cell cycle (Xu et al 2017). This mechanism was further confirmed by the upregulation of senescence-associated genes, including p21, p16, and p27.…”

Section: Radiation Therapymentioning

confidence: 91%

Hypertrophic scars and keloids: a review and current treatment modalities

et al. 2020

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Hypertrophic scars (HTS) are raised, red, rigid, inflexible cell-like, and cosmetic problems precipitated due to multiple underlying dermal injuries such as burn, surgery, and trauma during which aberrant wound healing with more pathological deposition of the extracellular matrix than degradation leads to their spawning. Till date, well established and specific treatments for HTS have not been reported; hence, the need of recent developments is thrusted with novel drug delivery vision. This review will try to encompass all the agogs to HTS, definition, pathophysiology, mechanism of hypertrophic scar formation, the role of growth factors in hypertrophic scarring, and their difference with keloids. Further, it will illuminate the available medicaments and recent advances in novel topical drug delivery systems such as ethosomes, transethosomes, liposomes, solid lipid nanoparticles, and microsponges for treatment of HTS.

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The radiation therapy in keloids treatment: a comprehensive review of pathomechanism, damage mechanisms and cellular response

Cited by 4 publications

References 23 publications

Lesion Site Is the Key Prognostic Factor for Keloid Patients Receiving Surgery With Adjuvant Radiotherapy

Lesion Site Is the Key Prognostic Factor for Keloid Patients Receiving Surgery With Adjuvant Radiotherapy

Vascular and Collagen Target: A Rational Approach to Hypertrophic Scar Management

Hypertrophic scars and keloids: a review and current treatment modalities

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