| Objective:Part Ⅰ: This study investigated the efficacy and safety of early postoperative radiaotherapy for earlobe keloid and complete all radiotherapy within a short time,providing a new idea and scheme for clinical treatment of earlobe keloid.Part Ⅱ: In this study,we explored the local control effect of postoperative electronic radiotherapy for keloid and new recurrence risk factors,and clarified whether the addition of adjuvant triamcinolone can improve the local control,so as to provide reference for clinical treatment of keloid.Methods:Part Ⅰ: Clinical data of 23 patients with 30 earlobe keloids admitted to the outpatient department from January 2011 to July 2017 were analyzed.All enrolled patients were given the first radiotherapy within 2 hours after surgery.The radiotherapy segmentation scheme was 5Gy×3F,and the remaining two radiotherapy sessions were completed in the next one to two days.Radiotherapy should be performed at least 6hours apart.There was no other adjuvant treatment after radiotherapy.Follow-up was conducted at 3 months,6 months,1 year and annually thereafter.The primary outcome was local control rate,and the secondary outcome was treatment-related early and late side effects.Part Ⅱ: The clinical data of 82 patients from January 2015 to October 2019 were collected,including general condition of patients,clinical characteristics of keloids,treatment plan,local control and side effects of treatment.Kaplan-Meier method and Multivariate Cox regression analysis were used to analyze the local control rate and its related influencing factors.Cox regression and forward step-by-step regression probability test based on maximum likelihood estimation were used for Multivariate analysis.In this study,p<0.05 was considered statistically significant.Results:Part Ⅰ: Among the 30 earlobe keloids,5(16.7%)was primary and 25(83.3%)was recurrent keloids.After a median follow-up period of 26 months(14-93 months),the overall local control rate was 86.7%.None of the patients occurred treatment-related grade ⅡI or higher complications.Part Ⅱ: A total of 82 patients with 129 keloids were enrolled.There were 23 males(28%)and 59 females(72%).Median age was 32 years(18-67 years).A total of 26 cases recurred after treatment,and 1-year,3-year and 5-year local control rates were93%,81% and 73%,respectively.Univariate analysis showed that age(p=0.025),hypertension(p=0.035),scar shape(p<0.001),primary site(p=0.021),maximum diameter of the lesion(p<0.001),pain and itching symptoms(p=0.005),local tension(p=0.005),and infection(p<0.001)were independent influencing factors for local control of keloid after treatment.Multivariate analysis showed that the maximum diameter of keloid lesion(p<0.001),local infection(p<0.001),interval time between surgery and radiotherapy(p=0.023),and previous treatment history(p=0.020)were the independent influencing factors for local control rate.Conclusions:Part Ⅰ: Our results show that the completion of three-fractional radiotherapy within 2days after complete surgical resection of keloid in the earlobe is safe and effective for the prevention of recurrence and can improve patient compliance and comfort.Part Ⅱ: Complete surgical excision of keloid combined with external electronic radiotherapy is safe and effective.After surgery combined with adjuvant radiotherapy,additional adjuvant therapy with triamcinolone had no significant benefit on local control.For keloid with a high risk of recurrence,more aggressive treatment should be chosen,and further prospective studies are needed to explore the optimal treatment. |
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