Sandwich Therapy with Radionuclide Combined with Intralesional Injections Based on Differences in the Spatial...

Complications such as ulceration, depigmentation, and recurrence limit the use of intralesional injections and brachytherapy in keloid treatment. We designed a modified "sandwich" therapy based on the spatial distribution of keloid components to reduce the incidence of these complications.

First, we analyzed the spatial distribution pattern of scar tissue through single-cell sequencing analysis, ultrasound, and pathology. Subsequently, a "sandwich" therapy combining radionuclide and intralesional injections was designed based on the pattern found in the previous stage. Finally, 40 patients with keloid scars at 41 sites were included in the clinical trial.

Single-cell sequencing identified two significant cellularly highly expressed genes and enriched pathways in the keloid vascular wall that primarily play essential roles in angiogenesis and promoting collagen synthesis, thereby promoting scar growth. Color ultrasound showed that there were hierarchical differences in the blood supply of the keloid, and further H&E, CD34, and eNOS staining showed that there were hierarchical differences in the spatial structure of blood vessels, fibroblasts, and collagen in the keloid. In clinical studies, the complication rate of "sandwich" therapy is lower than that of conventional treatment.

The distribution of blood vessels and collagen in keloid scars is characterized by spatial variability. The "sandwich" therapy of radionuclide combined with intralesional injections is a modified type of precisely targeted therapy designed based on this variability; it has fewer complications and good clinical efficacy and is worthy of popularization.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .