Clinical Effect Analysis Of Surgery Combined With Radiotherapy For Keloids

PurposeThere are various treatment methods for keloids,but the recurrence rate of single therapy is high,and surgery combined with postoperative radiotherapy can effectively reduce the recurrence rate.The methods of radiotherapy mainly include X-ray,short-range isotope radiotherapy,and electron beam.At present,the most commonly used in clinical is the electron beam,but there is no unified standard.By exploring the effects of different radiotherapy methods on the treatment of keloids after resection,some ideas and methods are provided for the treatment of orthopedic keloids.Methods1.Data collection: A total of 64 patients(106 lesions)diagnosed as keloids in parallel with surgery and postoperative radiotherapy in the first affiliated hospital of Zhengzhou University from June 2017 to May 2019 were selected.According to different radiotherapy methods,they are divided into electron beam group(group A)and isotope 90 strontium group(group B).The patient’s clinical data,prognosis,recurring factors,etc.were elaborated and retrospectively analyzed.2.The data obtained were statistically processed using SPSS21.0,chi-square test,fisher’s exact test and Logistic regression analysis,with α = 0.05 as the test level,P <0.05 was statistically significant.Results21 lesions recurred of the 106 keloids,and the total effective rate was 80.19%(85/106).There were 12 lesions of recurrence in group A,with an effective rate of81.54%(53/65),and 9 lesions of group B recurred,with an effective rate of 78.05%(32/41),and there was no significant difference in the effective rates between the two groups(P> 0.05).The recurrence rate is different in different parts,the anterior chest wall recurrence rate is 37.50%(9/24),the shoulder and back are 31.25%(5/16),the ears are 8.00%(2/25),and other parts are 12.20%(5/41),and the difference has statistical significance(χ2=9.492,P<0.05).Through a single factor analysis,it was found that the long axis diameter × short axis diameter × thickness and the location of keloids were the influencing factors of recurrence.The recurrence rate of keloids with a product of long axis diameter × short axis diameter × thickness greater than or equal to 2.5 cm3 was higher(χ2=4.006,P<0.05).Recurrence rate was higher in areas with high tension(anterior chest wall,shoulder and back)than in areas with low tension(ears and other areas)(χ2 = 9.329,P <0.05).Gender,age,and keloid long axis diameter are not factors influencing recurrence.Logistic multivariate analysis was used to correct confounding factors,and it was found that gender,age,long axis diameter and radiotherapy method were not factors affecting recurrence.Long axis diameter × short axis diameter × thickness and the location were independent risk factors(OR> 1,P<0.05).The incidence of adverse reactions was 23.58%(25/106).Most of the adverse reactions were mild,most of which were grade 1-2 reactions.Only 1 case(0.94%)had local inflammatory reactions in the incision during radiotherapy,and healed well after stopping the radiotherapy and dressing change.No malignant transformation was observed in all cases during the follow-up period.There was no significant difference in the incidence of adverse reactions between group A and group B(P>0.05).73.44% of patients were satisfied with the treatmentprocess and results,generally 18.75%,and 7.81% were dissatisfied.The satisfaction of patients is related to the treatment effect,and the satisfaction is high when the treatment effect is good(P<0.001).There was no significant difference in satisfaction between group A and group B.Conclusions1.For the treatment of keloids,there is no significant difference in the recurrence rate between the close-range 90 strontium radiotherapy and the electron beam radiotherapy after operation.They both can achieve satisfactory results,effectively control the recurrence,and have minor adverse reactions,safe and effective.2.The location of the lesion and the diameter of the long axis × the diameter of the short axis × the thickness are independent risk factors that affect recurrence.The location of high tension and the result greater than or equal to 2.5 cm3 have a higher recurrence rate.Gender,age and the long axis diameter have no effect on the recurrence rate.