Outcomes And Analysis Of Factors Influencing The Effect Of Radiotherapy For Recurrence Of Keloid After Surgery

Background and Objective: Keloid is a common disease. It is a kind of hyperplasia formed in the process of healing after skin injury of abnormal scar tissue. Clinically, keloid is mostly red and even purple, accompanied by itching or pain and other symptoms. Present studies on keloids are mainly about molecular pathogenesis of normal skin during wound healing. At this stage that the fibroblasts of pathological processes has an extremely important role, accompanied by various factors regulating. Because of its pathogenesis still under study, the pathogenes is is not entirely c lear. At present with a variety of treatments, but the rate of the recurrence in s ingle method is still high, A variety of treatment combination has become the mainly treatment of keloids in clinical work. Clinical practice shows that after surgical resection combined with electron beam radiation therapy can improve the effic iency of treatment of keloids. at present, It has become the main method of treatment of keloids. In practice, therapeutic dose of Surgical exc ision combined with electronic line treatment of keloids desired has not achieved a unified standard.In this study, By surgical excis ion combined with electron beam radiation therapy of 156 patients with keloid and Analysis of clinical efficacy and recurrence of evaluation, we can investigate the efficacy electron beam radiation therapy after surgery keloid and analyze the influenc ing factors associated with recurrence after treatment of keloids. We can guide the clinical treatment of keloids with application of more rational program. At the same time, we still have to pay attention to the risk factors related to early prevention.Methods l.The Information is from April 2007 to February 2014 for treatment in radiation therapy department of China-Japan Union hospital of Jilin University, clinically diagnosed of keloid. They used the method of surgery combined with electron beam radiation therapy. The number of the patients is 156. Because of phone disconnected or the phone number errors, we lost 28 cases. Lost rate is 17.95%. Success cases are 128. Male cases are 42, while female cases are 86.Age range from 5 to 63 years(the median 24.73 ± 12.4 years). Distribution parts: fac ial:6, lobe :52, chest shoulder:64, abdomen:8, limbs: 16, perineum:10. The number of the cases receiving over 20 Gy is 126,while the number of the cases receiving less than 20 Gy is 30 Gy. 2. Radiation therapy :The patients cut off the keloid in surgical department.Within 24 hours after operation,we use Elekta Synergy linear accelerator to radiate the scars. Electron beam dose is 6Me V or 9Me V,It is source skin distance irradiation technology, and the radiation field covers the periphery of the les ion(Inc luding the suture needle) 1cm.Keloid irradiation is all added up 0.5cm~1.0cm thick film equivalent to increase radiation dose of the surface. For keloid on chest、shoulder and back, Row CT examination before radiation therapy to determine the depth of the scar tissue. Then determine the electron energy. A single dose of 2Gy, a total of 10 times or 15 times, the total dose of 20 or 30 Gy. For the other parts, a single dose of 2Gy, a total of 10 times, the total dose of 20 Gy. 3. Follow-up records: Get results by telephone or outpatient review after at least one year after radiotherapy. 4. therapeutic evaluation: Evaluation criteria in accordance with keloid treatment evaluation criteria:(1) Cure : Symptoms are disappeared 、nothickening of the wound、no recurrence after operation for at least 1 year.(2) Markedly: For the self-conscious symptom disappeared or almost disappeared、no significant thickening in more than 60% of the treatment site、part soft, can be a little pigmentation. There is no obvious growth and keloid self-conscious symptom in at least 1 year after treatment(3) Null:No significant change in keloid skin lesions within 1 year of treatment 、No significantly reducing of the symptoms after treatment,recurrence in1 year.(4) Effective rate: the number of cured and markedly percentage of total. 5. Adverse reactions: On the basis of RTOG, assess the skin side effects and the possibility of radiation causing cancer. 6. Statistics: Using SPSS software. X2 method performed statistical analys is of the factors affecting the efficacy, P <0.05 is considered statistically significantResults According to the criteria of the treatment of keloids: 1.The efficiency rate of 156 keloids postoperative electron beam therapy is 78.21%. 2.Efficiency of female patients is 80.58%, while effic iency rate of male patients is 73.58%,P>0.05.Gender has no significant difference on the efficiency rate. 3.Age has no significant difference on the efficiency rate.. 4.Efficiency rate of the patients whose dose achieved 20 Gy is 82.54%,while efficiency rate of the patients whose dose did not achieved 20 Gy is 60%. P<0.05.The dose achieving 20 Gy or not has significant difference on the efficiency rate. 5. Efficiency rate of low-tension parts is 86.36%, while effic iency rate of high-tension parts is 72.22%,P<0.05. low-tension parts or not has significant difference on the efficiency rate. 6.The total number of the keloids on chest、should、back is 64.The number of completing 10 times is 60. The number of cases achieving total dose of 20 Gy is 31. The efficiency rate is 72.50%. The number of cases achieving total dose of 30 Gy is 29. The efficiency rate is 82.76%. The efficiency rate of the total dose of 30 Gy is higher than The efficiency rate of the total dose of 20 Gy. P>0.05. The total dose of 30 Gy or 20 Gy has significant difference on the inefficiency rate. 7. There are 8 cases having acute radiation reaction which standard depending on RTOG.There are 2 cases having late s ide radiation reaction which standard depending on RTOG. Related cancer did not came up during the follow-up periodConclusion 1.Within 24 hours after operation, electron beam radiotherapy of the keloid is an effective method for the treatment. Radiotherapy on the keloid after surgery has little side effect.radiotherapy for keloid after surgery can be the standard treatment. 2.the higher tension parts(chest back should)have lower effic iency rate than and the lower tension parts(lobe face). 3.The dose achieving 20 Gy or not have statistically s ignificant correlation on the relapse,while the higher dose do not has higher efficiency. 4.The gender and age have no statistically significant correlation on the relapse.