Surgical excision and postoperative radiotherapy forkeloids

摘要

Keloids can be treated in a number of ways, including by surgery. Multiplestudies now show that while surgical monotherapy associates with extremely highrates of recurrence (50%–80%), postoperative radiotherapy can significantlyreduce these recurrence rates. Ongoing improvements in radiation technology havefurther increased the safety and efficacy of this combination protocol. Of thevarious radiotherapies that have been used in this setting, electron beam(β-ray) irradiation is currently the best due to its excellent dose distributionand safety. The maximal biologically effective dose (BED) for keloids is 30 Gy(using an estimated α / β ratio of 10); increasing the dose has no furtherbenefits and elevates side effects. Over the last two decades, we have modifiedand then fine-tuned our radiotherapy protocol for keloid excision wounds. Thus,our early protocol was used for all body sites and consisted of 15 Gy/3 fr/3days. We then customised the radiotherapy protocol so that body sites that arehighly prone to recurrence (e.g. the anterior chest) receive higher doses whilelow recurrence sites like the earlobe receive a much smaller dose. Morerecently, we tweaked this body site-customised protocol so that fewer fractionsare employed. Therefore, we currently apply 18 Gy/3 fr/3 days to high-recurrencesites, 8 Gy/1 fr/1 day to earlobes and 15 Gy/2 fr/2 days to other body sites.These radiotherapy protocol changes were accompanied by the evolution of bodysite-customised surgical approaches. As a result of these developments, ouroverall keloid recurrence rate is now below 10%.