Clinical Effect Analysis Of Two Radiotherapy Methods After Ear Keloid Surgery

Background: Keloids are caused by hyperplasia of local connective tissue after skin injury,its essence is a fibrous tissue tumor on the skin.At present,the pathogenesis of this disease is unclear.Ear keloids are common in young women.The clinical manifestations are not only persistent growth and itching but also serious aesthetic impact.Ear keloids bring great distress to patients.Ear keloid surgery combined with postoperative radiotherapy is currently recognized as more effective combined therapy,however,the selection of radioactive sources、time of radiotherapy、single dose 、 total dose and frequency of treatment are still inconsistent and need further study.Objective: To investigate the curative effect of conventional segmentation and large segmentation radiotherapy after ear keloid surgery and the factors affecting the recovery,thus,it provides the basis for the selection of postoperative treatment for ear keloid and the judgment of its recovery.Methods: The study was conducted with the consent of the patients.The patients in this study were ear keloid patients admitted to the Department of Plastic Surgery of the First Affiliated Hospital of Dalian Medical University from July 2017 to July 2022.The experimental design was a randomized controlled study.Patients who were willing to undergo ear keloid surgery combined with electron line radiation therapy were enrolled.The enrolled patients were selected strictly according to inclusion criteria and exclusion criteria.The clinical data of all patients were recorded and counted.The enrolled patients were selected strictly according to inclusion criteria and exclusion criteria,the clinical data of all patients were recorded and counted.Patients were randomly divided into experimental group and control group according to the total dose、single dose and radiation frequency.Experimental group received postoperative radiotherapy with a single dose of 3 Gy,once every other day,a total of 5 times,total dose of 1 5 Gy.Control group received postoperative radiotherapy with a single dose of2 Gy,once a day,5 times a wee k,8 times in total,and a total dose of 1 6 Gy.The time of radiotherapy in both groups was controlled within 2 4 hours after surgery.All of them were treated with 6Me V generated by Elekta-Axesse 4 9 6 9 linear accelerator in the First Affiliated Hospital of Dalian Medical University,and the source skin distance was equal to 1 0 0 cm.Follow-up time of both groups was longer than12 months.Result: A total of 47 cases were enrolled,including 2 3 in experimental group and 24 in control group,at 1 2 month of follow-up,in the experimental group,1 8 patients were cured,3 patients had obvious effect and 2 patients had relapse the total effective rate was 9 1.3 %;In the control group,1 7 patients were cured,2patients had obvious effect and 5 patients had relapse,the total effective rate was7 9.2 %.The effective rate of two groups was compared.The statistical analysis indicated that P>0.05 was not statistically significant a n d both combined treatments were effective.According to the Vancouver Scar Scale(VSS),the preoperative and one-year postoperative scores of the two groups of patients were statistically analyzed,indicating that the preoperative and one-year postoperative VSS scores of the two groups of patients were significantly different P< 0.0 1,suggesting that the two combined treatments were effective.Follow-up to one year after surgery,two patients in each group had short-term skin pigmentation at the irradiation site.But,with the passage of time,the pigmentation was gradually alleviated and subsided.No delayed wound healing or non-healing occurred in the two groups and the appearance of the ear basically maintained well.T h e r e a r e n o adverse reactions such as skin congestion、swelling and atrophy occurred in the irradiated site.There was no statistical significance in the probability of complication between the two groups(P>0.05).Correlation and univariate analysis of factors that might influence recurrence suggested a moderate correlation between family history of keloid and recurrence,which was also confirmed by univariate analysis.Family history was the only risk factor for recurrence in this study(P<0.01).So it can be considered that recurrence of keloid may be related to family history.Conclusion:1.Surgery combined with postoperative electron radiotherapy is an effective combination therapy for ear keloid.2.A single dose of 3Gy,a total of 5 times,a total dose of 15 Gy,once every other day of large segmentation therapy,low total dose,short course of treatment,small economic burden on patients,is worthy of recommendation of combination therapy.3.The recurrence of ear keloid is closely related to family history.