Treatment of so-called keloid with excision and postoperative electron irradiation.

Abstract

Between 1988 and 1994, 110 patients with 139 so-called keloids site, which had been treated with conservative therapy were treated with excision, suture, and postoperative irradiation with a 4 MeV electron beam. They were irradiated within one or two days after surgery, for three consecutive days. The total doses were 15 Gy or 18 Gy per fractions for the most part. Control rates of true keloids and hypertrophic scars were 76.0% (57/75) and 93.8% (60/64), respectively, and the overall effectiveness rate was 84.2%. No remarkable side effects were observed. Transient hyperpigmentation was found in 44.6%. No carcinogenesis have been found in our series of patients. Considering the possibility of recurrence, side effects, and carcinogenesis, the indication of our treatment was decided. The result of our treatment using a low-megavolt electron beam was similar to that of published series using a low-energy X-ray. The advantages of the use of electron beam are that the peak of dose is the layer of the occurrence of keloid, and that the depth of penetration of radiation is limited without appreciable effect on the deeper structures. At present, the equipments of low-energy X-ray have been disposed. Our treatment using a electron beam will be an effective treatment.

Global Gene Expression Analysis of Keloid Fibroblasts in Response to Electron Beam Irradiation Reveals the Involvement of Interleukin-6 Pathway

“…Thus, a 15 Gy dose was chosen for the cDNA microarray analyses. In addition, a comparable dose has been effectively used in several clinical and experimental studies to prevent keloid recurrences (Lo et al, 1990;Mitsuhashi and Miyashita, 1995;Maarouf et al, 2002;Ogawa et al, 2003).…”

“…Although simple excision and closure result in a recurrence rate of more than 50%, several studies have shown that surgery associated with post-operative EB irradiation provide more than 70% success rate in prevention or recurrence of keloids (Lo et al, 1990;Mitsuhashi and Miyashita, 1995;Ogawa et al, 2003). The molecular mechanism(s) behind the effect of EB irradiation has, however, not been explored.…”

“…In a randomized trial for keloid therapy, a combination of surgery and radiotherapy appeared to be more effective (12.5% relapse) than that of surgery and corticosteroid injections (33% relapse) at 12 mo after treatment (Sclafani et al, 1996). Although keloid radiotherapy alone without surgery is an exception, early postoperative electron beam (EB) irradiation has proved to be a well-tolerated and effective method in reducing the recurrence rate down to 12%-28% (Lo et al, 1990;Mitsuhashi and Miyashita, 1995;Maarouf et al, 2002;Ogawa et al, 2003). In general, EB irradiation appears to be preferable to kilovoltage radiotherapy when treating keloids, since with fast electrons, it is possible to achieve the most advantageous dose distribution in tissue with least undesirable effects (Maarouf et al, 2002).…”

Radiation Therapy in Keloids Treatment

“…Up to a dose of 15 Gy, irradiation given to the patients after surgical excision of hypertrophic scars successfully prevented hypertrophic scars or keloids formation and recurrence. [24] Relative lower recurrence rate was also reported after technology mainstay transition[2526] among Asians with keloids. Later, high-dose-rate (HDR) brachytherapy provided us with an alternative external radiation therapy, particularly for patients who are resistant to adjuvant external beam radiation therapy or corticosteroids, which resulted in a recurrence rate ranging from 4.7% to 21%.…”

Identification and Characterization of Wnt Signaling Pathway in Keloid Pathogenesis

“…The KFs and NFs had been characterized in terms of the cell growth and collagen synthesis properties as reported previously 32. Early passages 4-7 of cells were cultured in Dulbecco's modified Eagle's medium (DMEM), supplemented with 10% fetal calf serum, penicillin (100 IU/ml), streptomycin (100μg/ml), and amphotericin B (0.25μg/ml) at 37C in a humidified 5% CO2 incubator. The cultures were maintained until reaching 70 to 80% confluence.…”