Adjuvant Radiotherapy Following Surgical Excision of Keloids: A Systematic Review of Dose, Fractionation, and Recurrence

Dose Effect in Adjuvant Radiation Therapy for the Treatment of Resected Keloids

Recurrent pleomorphic adenoma of the parotid gland: Long-term outcome of patients treated with radiation therapy

Laser-assisted drug delivery in the treatment of keloids: A case of extensive refractory keloids successfully treated with fractional carbon dioxide laser followed by topical application and intralesional injection of steroid suspension

Treatments for keloids on the cartilaginous part of the auricle (i.e., the upper part of the ear excluding the earlobe) include surgical excision, cryosurgery, postoperative radiation therapy, steroid injection, taping stabilization, and pressure therapy. However, to date, there is no universally accepted treatment strategy for auricle keloids. In this retrospective cohort study, the 63 primary auricle keloids in all 57 patients who underwent surgery from 2006 to 2012 were included. Mild scars such as hypertrophic scars were excluded. All 63 scars were treated with surgery, namely, total excision or intralesional excision (core excision method), and postoperative adjuvant radiation therapy and self-managed scar stabilization with surgical tape. The postsurgical radiation therapy consisted of 15 Gy administered in three fractions over 3 days. The recurrence rates associated with the two surgical methods over 18 months of follow-up were recorded. Of the 57 patients, 91.2 percent were women. Of the 63 lesions, 95.2 percent and 4.8 percent were caused by piercing and trauma, respectively. All were primary keloids. Before 2009, all lesions (n = 37) were treated by total excision. After 2009, all lesions (n = 26) were treated by core excision. These methods were associated with recurrence rates of 8.1 percent and 0 percent, respectively, although this difference did not achieve statistical significance (p > 0.05). The overall recurrence rate was 4.8 percent. Complications such as wound dehiscence and pigmentation during the 18-month follow-up period were not observed. Auricle keloids can be treated by customized plans consisting of appropriate surgical modalities, postoperative radiotherapy, and self-management. Therapeutic, III.

Carcinoma of the tonsillar fossa: prognostic factors and long-term therapy outcome

Defining the optimal therapy for rectal cancer.

Impact of Total Thoracic Radiation Dose and Dose Fractionation on Overall Survival in Limited-Disease Small Cell Lung Cancer: A Retrospective Study on 456 Patients

Objective: Keloid offten occurs on chest wall, shoulder and back. Surgical incision and postoperative radiation is an effective method in keloid treatment. Many of the wound in these places can be directly closed after keloids being removed. Recurrence prevention and cosmetic result should all be considered. Operation method especially suture method is one of the key issues which determine the treatment result. Many methods have been developed. However, many of them are designated to prevent recurrence. Cosmetic result is not fully considered. In this article, we reported a new suture method which is with good treatment and cosmetic results in our clinical study. Methods: One hundred and thirty-three patients with chest keloids were treated from 2006 to 2011. Double layer continuous intradermal suture was used in fifty four patients, interrupted epidermal suture was used in forty one patients, and one layer continuous intradermal suture was used in thirty eight patients. All operation sites were treated with radiotherapy on the A¯Â¬Ârst and seventh postoperative day. The follow-up time was from 9 to 26 months. The recurrence rate and cosmetic satisfactory rate was recorded. Data was analyzed with SPSS17.0 software. Recurrence and satisfactory rate were compared with Chi-square test between double layer and interrupted suture, double layer and one layer suture. Results: There were no difference in recurrence rate between double layer and interrupted suture (X2=2.46, P>0.05) or double layer and one layer suture (X2=0.16, P>0.05). Satisfactory cosmetic rates were 72.22%, 29.27% and 39.47% in double layer continuous intradermal suture group, interrupted suture group and one layer continuous intradermal suture group. Difference in satisfactory cosmetic rates is obvious between double layer and interrupted suture (X2=9.30, P<0.01) or double layer and one layer suture (X2=9.05, P<0.01). Conclusion: Double layer continuous intradermal suture can reach good treatment results and more satisfactory cosmetic results in keloid operation.

Background:Keloids are dermal tumors that are due to increased production of collagen caused by abnormal and prolonged wound healing. The incidence of recurrence is extremely high if only conservative measures are used. This study was conducted to evaluate the feasibility and efficacy surgery and high dose rate brachytherapy as an adjuvant therapy for treatment of keloids.Materials and Methods:50 patients with clinically diagnosed 71 keloids were treated with excision of keloid and post-operative high-dose rate brachytherapy were studied. Complete excision of the keloid till the healthy skin margin was excised. The wound were closed in 2 layers. Subcutaneous tissue closed using absorbable suture, over which a 6F flexible polyethylene tube was placed. High dose rate cobalt-60 brachytherapy was administered. Total of 15 Gy in divided dose, 5 Gy in 3 fractions were administered.Results:50 patients with 71 keloids were studied. Out of the 50 patients, 12 were male (24%) and 38 were females (76%). Age of the patients ranged between 14 and 71 years. Recurrence rate was 2% with 2 keloids recurring at 5 months interval. 4 patients scored the results as unacceptable, remaining 45 patients rated their results as excellent during their follow up at 10 days, 3 months and 6 months.Conclusion:Treatment of keloids in the plastic surgeon’s practice even today is still challenging. Many therapies have been described, but recurrence rate is high with mono-therapy. Combination therapy especially surgical excision with postoperative radiotherapy is best in preventing recurrence.

Simple SummaryMedial sphenoid wing meningiomas are among the three most common intracranial meningiomas. They present a challenge to neurosurgeons, especially when they invade critical neurovascular structures and the cavernous sinus. This study was designed to evaluate prognostic features influencing recurrence and progression-free survival of medial sphenoid meningiomas invading the cavernous sinus, with a particular focus on the impact of surgery and postoperative radiotherapy. A retrospective analysis was conducted of the database of our institution. Included were 105 cases of medial sphenoid wing meningiomas with invasion of the cavernous sinus, of which 64 were treated by surgery alone and 41 were treated by surgery plus radiotherapy. Near-total resection did reduce the risk of tumor recurrence significantly compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy. In conclusion, we found that performing a maximal safe resection is the factor most strongly associated with a lower recurrence rate in patients with medial sphenoid meningioma infiltrating the cavernous sinus, and that postoperative stereotactic radiotherapy of the residual tumor also significantly prolongs PFS.Objective: Medial sphenoid wing meningiomas are among the three most common intracranial meningiomas. These tumors pose a challenge to neurosurgeons in terms of surgical treatment, as they may involve critical neurovascular structures and invade the cavernous sinus. In case of the latter, a complete resection may not be achievable. The purpose of this study was to investigate prognostic features affecting recurrence and progression-free survival (PFS) of medial sphenoid wing meningiomas involving the cavernous sinus, focusing on the contribution of surgery and postoperative radiotherapy. Methods: A retrospective analysis was conducted of the database of our institution, and 105 cases of medial sphenoid wing meningioma with invasion of the cavernous sinus, which were treated between 1998 and 2019, were included. Surgical treatment only was performed in 64 cases, and surgical treatment plus postoperative radiotherapy was performed in 41 cases. Kaplan–Meier analysis was conducted to estimate median survival and PFS rates, and Cox regression analysis was applied to determine significant factors that were associated with each therapeutic modality. Results: The risk of recurrence was significantly reduced after near-total resection (NTR) (p-value = 0.0011) compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy (p-value = 0.0002). Conclusions: Maximal safe resection and postoperative stereotactic radiotherapy significantly reduced the recurrence rate of medial sphenoid wing meningiomas with infiltration of the cavernous sinus.

ObjectiveIntracranial meningiomas are primarily benign tumors with a good prognosis. Although WHO grade II meningiomas are rare (2-10%), WHO grade II meningiomas have higher recurrence and mortality rates than benign. We evaluated the patient recurrence rate and investigated the prognostic factors of WHO grade II meningiomas.MethodsBetween 1993 and 2005, 55 patients were diagnosed with WHO grade II meningiomas in our hospital. WHO grade II meningiomas (n=55) were compared with other WHO grades meningiomas (I, n=373; and III, n=20). The patients had a median age of 48.4 years (range, 14-17 years), a male-to-female ratio of 26 : 29, and a mean follow-up time of 45 months (range, 3-175 months).ResultsIn WHO grade II meningiomas, only the extent of resection was a significant prognostic factor. Post-operative radiotherapy had no significant influence on tumor recurrence (p=0.053). The relative risk of recurrence was significantly higher in WHO grade II meningiomas with incomplete resection (10/27, RR=37%) than in WHO grade II meningiomas with complete resection (4/28, RR=14%) regardless of post-operative radiotherapy. In the incomplete resection group, Simpson grade III or IV had a significantly high risk of recurrence regardless of post-operative RT (n=3, RR=100%) However, if the degree of resection was Simpson grade II, the recurrence rate was similar to the complete resection group even though post-operative RT was not performed.ConclusionComplete resection was the most powerful independent predictive factor of the recurrence rate in WHO grade II meningiomas. Post-operative adjuvant RT was not a significant factor in this study.

Objective To explore the clinical efficacy and safety of using simple arthroscopic operation combined with post-operative radiotherapy in the treatment of knee joint diffuse pigmented villonodular synovitis (DPVNS). Methods A total of 30 cases with knee DPVNS in Wuhan Central Hospital and General Hospital of Beijing Military Region from January 2009 to January 2014 were enrolled, including 18 males and 12 females with average age of 42.5 years (28-64 years). The average duration was 35.6 months(4-121 months). According to the decision of the patients, 16 cases treated with operation combined with postoperative radiotherapy and the other 14 cases with operation alone. The treatment group accepted arthroscopic synovial excision and received local radiotherapy, the total dose of radiotherapy was 40 Gy, 2 Gy/fraction. While the control group received arthroscopic operation alone. Patients were followed up, which the average time of 38.7 months (12-72 months). The recurrence rate, clinical KSS score and function score were compared between the two groups. Results The efficiency of treatment group (14/16) was significantly higher than the control group (11/14) (χ2=9.87, P<0.05), and the recurrence rate of the former(1/16) was significantly lower than that latter (3/14)(χ2=1.83, P<0.05). Furthermore the KSS clinical score and function score were improved significantly in the treatment group(χ2=15.00, 15.78, P<0.05). The main side effect of radiation therapy were leucopenia, limb edema, skin pigmentation and so on, meanwhile the treatment group was well tolerated. Conclusions Arthroscopic operation combined with postoperative radiotherapy is safe and effective in treatment of DPVNS, and it is worthy of clinical application. Key words: Diffuse; Pigmented villonodular synovitis; Radiation therapy; Knee joint; Arthroscopic operation

Objective To evaluate the effect of postoperative radiotherapy on high\|risk endometrial carcinoma. Methods 126 patients were treated with surgery plus postoperative radiotherapy, 58 patients were treated with surgery alone as control. The rate of recurrence and 5\|year survival rate were observed. Results Between patients receiving surgery alone and surgery plus postoperative radiotherapy, there was statistically significant difference in rate of local recurrence and 5\|year survival rate in Patients with high\|risk stage ⅠorⅡedometrial carcinoma ( P 0.01), but there was no statistical difference in 5\|year survival rate in advanced patients. Conclusion Postoperative radiotherapy can reduce the rate of local recurrence and increase the 5\|year survival rate in Patients with high\|risk surgical stage ⅠorⅡendometrial carcinoma.

Various methods have been attempted for the treatment and management of keloids; however, there is little satisfactory clinical evidence in long-term follow ups. Also, there is a preference for occurrence and recurrence in anatomic location. Usually anatomic locations with higher regional tension and more sebaceous glands are inclined toward pathogenesis. Thirty-eight keloids treated with combined surgical excision and postoperative irradiation, using electron beams with only a 10-mm opening by lead shielding, were investigated at a mean follow up of 4.4 +/- 2.5 years (range, 1-9 years) at a single institute. Ten locations such as the ear (n = 6), neck (n = 3), and upper lip (n = 1) were among the craniofacial locations. The hardness of the keloids and posttreatment scars was clinically and objectively tested with the Vancouver scar scale and a durometer, which is often used for the industrial measurement of thread balls and rubber. At a mean of 4.4 +/- 2.5 years of follow up, the clinical characteristics of the scars were significantly better posttreatment as 2.6 +/- 0.5 versus 1.0 +/- 0.6, 3.7 +/- 0.7 versus 1.7 +/- 0.7, 2.9 +/- 0.4 versus 1.3 +/- 0.5, and 2.7 +/- 0.5 versus 1.3 +/- 0.5 (keloid scars versus posttreatment scars: pigmentation, pliability, height and vascularity, respectively, P < 0.01). The durometer readings were significantly lower posttreatment, 15.2 +/- 3.9 versus 7.7 +/- 2.9 (keloid scars versus posttreatment scars, P < 0.01). The recurrence rate was 21.2% overall with none in craniofacial locations. Therefore, the combined treatment of surgical excision and postoperative electron beam irradiation is effective for scar quality and reducing the recurrence rate in long-term follow up.

A malignant peripheral nerve sheath tumor is a rare and aggressive soft-tissue sarcoma that originates from Schwann cells or neural crest cells. Although 60% of cases are associated with neurofibromatosis type 1, approximately 10% occur secondary to radiotherapy. We report a malignant peripheral nerve sheath tumor that developed after radiotherapy for a keloid. A 35-year-old woman presented with a 7 × 9 cm left shoulder lesion 11 years after surgical treatment of a keloid followed by radiotherapy (20 Gy). Four years earlier, she had undergone a second operation with postoperative radiation (25 Gy) to address keloid recurrence. Biopsy was concerning for malignancy, the tumor was resected with a 2-cm margin, and reconstruction was performed using a latissimus dorsi flap. The lesion exhibited erosion and hemorrhage not seen in benign keloids, and histological examination of the surgical specimen revealed high-grade sarcoma. No recurrence has been observed during follow-up. The development of secondary malignancy after radiotherapy for keloids is exceedingly rare-only 6 cases have been reported, including ours. However, clinicians must be vigilant in all keloid patients undergoing radiotherapy. Rapid enlargement, erosion, or bleeding in previously treated keloids should raise suspicion for malignant transformation. Proper radiation protocols and protective measures are essential to mitigate the risk. Early recognition and surgical intervention are critical for achieving favorable outcomes.