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Can we use radiotherapy alone in the treatment of keloids?
Journal of the European Academy of Dermatology and Venereology
ELSEVIER
JEADV
5 (1995) 150-152
Can we use radiotherapy alone in the treatment of keloids? Sanjay S. Supe a,* , Anil K. Sharma a, A.C. Deka b, B.C. Deka b a Dept. of Radiation Physics, KMIO, Hosur Road, Bangalore, 560029 Karnataka, b Dept. of Radiotherapy, KCTRI, Hub& Karnataka, India
India
Abstract Objective The use of radiation for the treatment of keloids has been the topic of debate for years. Methods In this study, 46 symptomatic cases were treated with 90Sr-90YP-rays. Patients were given four fractions of 5 Gy per fraction either as weekly or twice weekly schedules. Results Radiation dose of 20 Gy given twice weekly in four fractions showed response in 92% of the cases as compared to 81% in those receiving four fractions of 5 Gy weekly. Conclusion Further studies with numerous dose fractionation schedules would open up new dimensions in the radiotherapy of keloids. Keywor&: Keloids; Keloids, radiotherapy; Radiotherapy
1. Introduction Keloids are dense fibrous growths of the skin, resulting from an overgrowth of fibroblastic tissue as it grows to occupy the site of injury. Radiotherapy plays an imporrtant role in the management of keloids. A wide variety of radiation sources and energies have been used till now [l-4]. In this report a retrospective analysis is undertaken so as to evaluate the optimum radiation dose fractionation schedule amongst two differing ones for 46 patients with keloids trreated with 90Sr-90Y P-rays.
* Corresponding author. Elsevier Science B.V. SSDIO926-9959(95)00079-8
2. Materials and methods 46 casesof keloids were treated with a 90Sr-90Y P-ray applicator during 1981 to 1988. The design, dosimetric and treatment aspects of this 90Sr-WY P-ray applicator have been reported elsewhere
[Sl. Two different time dose fractionation schedules were used for the treatments. 1. Four fractions of 5 Gy per fraction once weekly (25 pts), and 2. four fractions of 5 Gy twice weekly (21 pts). Patients were reviewed monthly for twelve months after completion of treatment for assessing the response to treatment. Variable amounts of flattening of lesion, relief from symptoms and restraint on further growth have been observed.
S.S. Supe et al. /J. Eur. Acad. Dermatol. Venereal.5 (1995) 150-152
Shoulder
151
Table 1 Treatment response vs fractionation schedule Dose schedule No. of pts (%)
Arm
(4
4 fractions of 5 Gy (weekly) 4 fractions of 5 Gy (twice weekly)
23/25 (92%)
Overall response
40/46 (87%)
17/21(81%)
were encountered in either group and majority of the treate sites were cosmetically acceptable. Three cases had depigmented areas in the keloid and surrounding skin and five had hyperpigmentaiton. In most of the cases the hyperpigmentation was only transient and only in one case was it persistent. 4. Discussion
Q
w lnfeotion 3
spon~pous --
Fig. l.(a) Site distribution of keloids. (b) Predisposing factors for keloids.
The commonest age group of patients in this study was between 10 and 30 years, the oldest patient being 71 years and youngest 8 years old. The distribution of keloids was unequal amongst the males and females. Of the 46 patients treated 26 were females and 20 were males. The percent distribution of keloids in different sites is given in Fig. l(a). The commonest sites were chest wall, extremities and the ears. The patients were questioned to determine etiology. The predisposing factors for development of keloids are shown in Fig. l(b). 3. Results The response of keloids for the two shedules is given in Table 1. No untoward complications
Radiotherapy alone was used earlier for treatment of keloids [2,6-121. Our patients were selected for the radiotherapy alone group when the keloid was of recent origin, still vascular, very thin and still growing, hence the good response rate (87%). The normal tissue reactions were found to be acceptable. We find that p-irradiation from the 90Sr-90Y source is quite an effective method of treatment of thin keloids. It results in complete relief from pain, itching and burning sensation. In 87% of the casesthe tenderness and blanching associated with keloids disapeared and most of the keloids are flattened completely. The radiotherapy treatment of keloids gives excellent cosmetic results. References [l] Ernst H, Besserer A, Flemming I. Strahlenprophylaxe von keloiden and Narbenhypertrophien. Strahlentherapie 1999;155:614-617. [2] King GD, Salzman FA. Keloid scars analysis of 89 patients. Surg Clin N Am 1970;50:595-598. [3] Malakar A, Ellis F, Paine CH. Keloid scars: a new method of treatment combining surgery with interstitial radiotherapy. Clin Radio1 1976;27:179-183.
152
S.S. Supe et al. /.I. Eur. Acad. Dermatol. Venereol. 5 (1995) 150-152
[4] Van Der Brenk HAS, Minty CCJ Radiation in the management of keloids and hypertrophic scars. Br J Surg 1960;47:595-605. [5] Supe SS, Supe SS, et al. Treatment of keloids by 90Sr-90Y P-rays. Strahlentherapie 1991;167:397-402. [6] Belisario J. The treatment of keloids. Acta Dermvenererol 1957;37:165-181. [7] Brown JR, Bromberg JH. Preliminary studies on the effect of time dose patterns in the treatment of keliods. Radiology 1963;80:298-302. [8] Cosman B, Crikelair GF, Gawlin JC, Lotles R. The
[9] [lo] [ll] [12]
surgical treatment of keloids. Plast reconstr Surg 1961;27:355-358. Edsmyr F, Larsson LG, Onyango J, Wanguru S, Wood M. Radiation therapy in the treatment of keloids in East Africa. Acta Radio1 Ther Phhys Biol 1974;13:102-106. Garb J, Stone MJ.: Keloids: Review of literature and a report of 800 cases. Am J Surg 1942;58:315-335. Kitlowski EA. Treatment of keloids and keloidal scars. Plast Reconstr Surg 1953;12:383-391. Tepmongkol P. Radiation therapy in treatment of keloids. J Med Ass Thai 1978;61:200-25.
ELSEVIER
JEADV
5 (1995) 150-152
Can we use radiotherapy alone in the treatment of keloids? Sanjay S. Supe a,* , Anil K. Sharma a, A.C. Deka b, B.C. Deka b a Dept. of Radiation Physics, KMIO, Hosur Road, Bangalore, 560029 Karnataka, b Dept. of Radiotherapy, KCTRI, Hub& Karnataka, India
India
Abstract Objective The use of radiation for the treatment of keloids has been the topic of debate for years. Methods In this study, 46 symptomatic cases were treated with 90Sr-90YP-rays. Patients were given four fractions of 5 Gy per fraction either as weekly or twice weekly schedules. Results Radiation dose of 20 Gy given twice weekly in four fractions showed response in 92% of the cases as compared to 81% in those receiving four fractions of 5 Gy weekly. Conclusion Further studies with numerous dose fractionation schedules would open up new dimensions in the radiotherapy of keloids. Keywor&: Keloids; Keloids, radiotherapy; Radiotherapy
1. Introduction Keloids are dense fibrous growths of the skin, resulting from an overgrowth of fibroblastic tissue as it grows to occupy the site of injury. Radiotherapy plays an imporrtant role in the management of keloids. A wide variety of radiation sources and energies have been used till now [l-4]. In this report a retrospective analysis is undertaken so as to evaluate the optimum radiation dose fractionation schedule amongst two differing ones for 46 patients with keloids trreated with 90Sr-90Y P-rays.
* Corresponding author. Elsevier Science B.V. SSDIO926-9959(95)00079-8
2. Materials and methods 46 casesof keloids were treated with a 90Sr-90Y P-ray applicator during 1981 to 1988. The design, dosimetric and treatment aspects of this 90Sr-WY P-ray applicator have been reported elsewhere
[Sl. Two different time dose fractionation schedules were used for the treatments. 1. Four fractions of 5 Gy per fraction once weekly (25 pts), and 2. four fractions of 5 Gy twice weekly (21 pts). Patients were reviewed monthly for twelve months after completion of treatment for assessing the response to treatment. Variable amounts of flattening of lesion, relief from symptoms and restraint on further growth have been observed.
S.S. Supe et al. /J. Eur. Acad. Dermatol. Venereal.5 (1995) 150-152
Shoulder
151
Table 1 Treatment response vs fractionation schedule Dose schedule No. of pts (%)
Arm
(4
4 fractions of 5 Gy (weekly) 4 fractions of 5 Gy (twice weekly)
23/25 (92%)
Overall response
40/46 (87%)
17/21(81%)
were encountered in either group and majority of the treate sites were cosmetically acceptable. Three cases had depigmented areas in the keloid and surrounding skin and five had hyperpigmentaiton. In most of the cases the hyperpigmentation was only transient and only in one case was it persistent. 4. Discussion
Q
w lnfeotion 3
spon~pous --
Fig. l.(a) Site distribution of keloids. (b) Predisposing factors for keloids.
The commonest age group of patients in this study was between 10 and 30 years, the oldest patient being 71 years and youngest 8 years old. The distribution of keloids was unequal amongst the males and females. Of the 46 patients treated 26 were females and 20 were males. The percent distribution of keloids in different sites is given in Fig. l(a). The commonest sites were chest wall, extremities and the ears. The patients were questioned to determine etiology. The predisposing factors for development of keloids are shown in Fig. l(b). 3. Results The response of keloids for the two shedules is given in Table 1. No untoward complications
Radiotherapy alone was used earlier for treatment of keloids [2,6-121. Our patients were selected for the radiotherapy alone group when the keloid was of recent origin, still vascular, very thin and still growing, hence the good response rate (87%). The normal tissue reactions were found to be acceptable. We find that p-irradiation from the 90Sr-90Y source is quite an effective method of treatment of thin keloids. It results in complete relief from pain, itching and burning sensation. In 87% of the casesthe tenderness and blanching associated with keloids disapeared and most of the keloids are flattened completely. The radiotherapy treatment of keloids gives excellent cosmetic results. References [l] Ernst H, Besserer A, Flemming I. Strahlenprophylaxe von keloiden and Narbenhypertrophien. Strahlentherapie 1999;155:614-617. [2] King GD, Salzman FA. Keloid scars analysis of 89 patients. Surg Clin N Am 1970;50:595-598. [3] Malakar A, Ellis F, Paine CH. Keloid scars: a new method of treatment combining surgery with interstitial radiotherapy. Clin Radio1 1976;27:179-183.
152
S.S. Supe et al. /.I. Eur. Acad. Dermatol. Venereol. 5 (1995) 150-152
[4] Van Der Brenk HAS, Minty CCJ Radiation in the management of keloids and hypertrophic scars. Br J Surg 1960;47:595-605. [5] Supe SS, Supe SS, et al. Treatment of keloids by 90Sr-90Y P-rays. Strahlentherapie 1991;167:397-402. [6] Belisario J. The treatment of keloids. Acta Dermvenererol 1957;37:165-181. [7] Brown JR, Bromberg JH. Preliminary studies on the effect of time dose patterns in the treatment of keliods. Radiology 1963;80:298-302. [8] Cosman B, Crikelair GF, Gawlin JC, Lotles R. The
[9] [lo] [ll] [12]
surgical treatment of keloids. Plast reconstr Surg 1961;27:355-358. Edsmyr F, Larsson LG, Onyango J, Wanguru S, Wood M. Radiation therapy in the treatment of keloids in East Africa. Acta Radio1 Ther Phhys Biol 1974;13:102-106. Garb J, Stone MJ.: Keloids: Review of literature and a report of 800 cases. Am J Surg 1942;58:315-335. Kitlowski EA. Treatment of keloids and keloidal scars. Plast Reconstr Surg 1953;12:383-391. Tepmongkol P. Radiation therapy in treatment of keloids. J Med Ass Thai 1978;61:200-25.