広範囲または切除不能ケロイド患者に対する一次放射線療法の転帰
Tsai-Ling Tsai1, Yu-Chi Huang1, Yi-Han Chang2
1Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Introduction:
Keloids are scars that grow beyond their original margins, typically presenting as pigmented, thickened lesions accompanied by pain and pruritus that affects patients' quality of life. Keloids can be resectable or unresectable, and currently, no gold standard treatment exists for widespread or unresectable keloids. Radiotherapy is effective for keloids but the efficacy and safety of primary radiotherapy for unresectable keloids has rarely been reported. Our study aims to evaluate the clinical outcomes of primary radiotherapy as a definitive treatment for widespread or unresectable keloids. The primary endpoint is radiotherapy response, including symptomatic and cosmetic improvement. The secondary endpoint is the recurrence rate after radiotherapy.
Methods:
We retrospectively reviewed 35 patients with 64 keloid lesions treated with primary radiotherapy between January 2010 and July 2023. All received 30 Gy in six fractions. Treatment modalities, including 6 MeV or 9 MeV electrons and photon-based intensity-modulated radiotherapy (IMRT), were individualized according to lesion thickness and anatomical complexity. Clinical improvements were evaluated using the visual analog scale (VAS), Vancouver Scar Scale (VSS), and Japan Scar Workshop (JSW) Scar Scale. Longitudinal outcomes were analyzed using generalized estimating equations.
Results:
Prominent symptomatic relief and cosmetic improvement were achieved with primary radiotherapy, with significant and sustained reductions in the VAS, VSS, and JSW scores during follow-up. Disease control was excellent, with no cases of recurrence or serious adverse events.
Conclusion:
Primary radiotherapy is safe and effective for unresectable or extensive keloids. Both electron and photon beams provided reliable symptomatic relief, local control, and favorable cosmetic outcomes. Modern radiotherapy techniques, such as IMRT, provides similar efficacy with greater adaptability and may offer an innovative therapeutic option for challenging keloid cases. These findings highlight the expanding role of radiotherapy for benign but symptomatic dermatologic conditions.
