Postoperative radiotherapy with an electron beam on keloid scar: epidemiological evaluation in a teaching hospital

MENEZES NETO, BALDUINO FERREIRA DE; MAGNANI, LUCAS VANNUCHI; OLIVEIRA JÚNIOR, BATISTA DE; PALHARES NETO, ARISTIDES AUGUSTO

doi:10.5935/2177-1235.2023RBCP0691-EN

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 38 (2) • 2023 • https://doi.org/10.5935/2177-1235.2023RBCP0691-EN copy

Postoperative radiotherapy with an electron beam on keloid scar: epidemiological evaluation in a teaching hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Keloids are one of the most aggressive spectrums of healing disorders. They have a unique pathophysiology and multiple specific genetic and cellular factors, which have not yet been fully elucidated. So far, literature reviews have found the influence of genetics, injury site, and ethnicity on the incidence and rate of recurrence. Furthermore, the need to associate an adjuvant method with surgical excision has already been verified, but the best therapy has yet to be defined.

Method:

A retrospective analysis of medical records was carried out to assess the profile of patients who underwent postoperative radiotherapy with an electron beam to treat keloids at the Hospital das Clínicas da Faculdade de Medicina de Botucatu between 2015 and 2019.

Results:

Data from 131 patients were evaluated, with 269 keloid scars treated. The average duration of treatment was 51 days, and the number of sessions was 17. White patients were predominant (78%) and women (70%), with surgical incision being the main cause of formation (49%) and ear the most identified location (33%). Women were more likely to complete the proposed treatment (p=0.04), while non-literates completed less than those who had at least completed primary or secondary education (p<0.0001).

Conclusion:

Postoperative radiotherapy for keloid scars is a well-established treatment in the literature and an important tool for plastic surgeons. Knowing the profile of patients who need this therapy is essential to create methods that improve adherence and results.

Keywords:
Keloid; Scar; Radiotherapy, adjuvant; Reconstructive surgical procedures; Medical records

	Year				P
	2015	2016	2017	2018	P
Age (in years)	31.5	29.2	33.5	31.9	0.17
Age (in years)	12.9	10.7	11.8	10.9	0.17
Doses	3164.0	3394.7	3668.2	3994.8	<0.001
Doses	991.1	834.6	835.4	574.0	<0.001
Number of applications	15.7	17.0	18.5	19.9	<0.001
Number of applications	5.0	4.2	4.3	2.9	<0.001
Time (in days)	36.1	37.4	46.1	56.2	<0.001
Time (in days)	19.6	17.7	16.2	17.7	<0.001

Year	Race					Total
Year	Yellow	White	Brown	Black	N/D	Total
2015	-	37	6	two	5	50
2015	0.0	74%	12%	4%	10%	100 (%)
2016	-	70	-	6	-	76
2016	0.0	92.1%	0.0	7.9%	0.0	100 (%)
2017	-	39	3	15	9	66
2017	0.0	59.1%	4.6%	22.7%	13.6%	100 (%)
2018	3	66	1	4	3	77
2018	3.9%	85.7%	1.3%	5.2%	3.9%	100 (%)
Total	3	212	10	27	17	269
Total	1.1%	78.8%	3.7%	10%	6.3%	100 (%)

Cause	Year				Total
Cause	2015	2016	2017	2018	Total
Acne	-	1	2	2	5
Acne	0.0	1.3%	3%	2.6%	1.9%
Earring	18	14	-	-	32
Earring	36%	18.4%	0.0	0.0	11.9%
Spontaneous	-	-	-	1	1
Spontaneous	0.0	0.0	0.0	1.3%	0.4%
CBW	2	4	-	1	7
CBW	4.0%	5.3%	0.0	1.3%	2.6%
Folliculitis	0	1	1	-	2
Folliculitis	0.0	1.3%	1.5%	0.0	0.7%
Incision	19	37	34	42	132
Incision	38%	48.7%	51.5%	54.5%	49.1%
Bite	2	-	-	-	2
Bite	4%	0.0	0.0	0.0	0.7%
Burn	1	2	-	-	3
Burn	2%	2.6%	0.0	0.0	1.1%
N/D	6	17	27	31	81
N/D	12%	22.4%	40.9%	40.3%	30.1%
Tumor	1	-	2	-	3
Tumor	2%	0.0	3%	0.0	1.1%
Wart	1	-	-	-	1
Wart	2%	0.0	0.0	0.0	0.4%
Total	50	76	66	77	269

Location	Year				Total
Location	2015	2016	2017	2018	Total
Abdomen	11	14	21	15	61
Abdomen	22%	18.4%	31.8%	19.5%	22.7%
Armpit	-	-	-	2	2
Armpit	0.0	0.0	0.0	2.6%	0.7%
Hip	-	-	-	2	2
Hip	0.0	0.0	0.0	2.6%	0.7%
Arm	-	5	-	1	6
Arm	0.0	6.6%	0.0	1.3%	2.2%
Thigh	1	-	-	-	1
Thigh	2%	0.0	0.0	0.0	0.4%
Back	1	-	2	2	5
Back	2%	0.0	3%	2.6%	1.9%
Sternum	2	1	2	1	6
Sternum	4%	1.3%	3%	1.3%	2.2%
Face	-	-	3	-	3
Face	0.0	0.0	4.5%	0.0	1.1%
Inguinal	3	-	-	-	3
Inguinal	6%	0.0	0.0	0.0	1.1%
Lip	1	-	-	-	1
Lip	2%	0.0	0.0	0.0	0.4%
Lobe	12	-	-	-	12
Lobe	24%	0.0	0.0	0.0	4.5%
Breast	6	23	10	25	64
Breast	12%	30.3%	15.2%	32.5%	23.8%
Hand	-	1	-	-	1
Hand	0.0	1.3%	0.0	0.0	0.4%
Shoulder	2	2	-	1	5
Shoulder	4%	2.6%	0.0	1.3%	1.9%
Ear	10	24	20	22	76
Ear	20%	31.6%	30.3%	28.6%	28.3%
Leg	-	1	-	-	1
Leg	0.0	1.3%	0.0	0.0	0.4%
Neck	1	2	3	3	9
Neck	2%	2.6%	4.5%	3.9%	3.3%
Fist	-	-	1	-	1
Fist	0.0	0.0	1.5%	0.0	0.4%
Chest	-	3	4	3	10
Chest	0.0	3.9%	6.1%	3.9%	3.7%
Total	50	76	66	77	269

Education	Year				Total
Education	2015	2016	2017	2018	Total
Elementary 1	1	1	3	1	6
Elementary 1	2%	1.3%	4.6%	1.3%	2.2%
Elementary 2	15	11	8	6	40
Elementary 2	30%	14.5%	12.1%	7.8%	14.9%
Average	16	34	25	28	103
Average	32%	44.7%	37.9%	36.4%	38.3%
Illiterate	1	-	2	6	9
Illiterate	2%	0.0	3%	7.8%	3.4%
N/D	5	1	19	7	32
N/D	10%	1.3%	28.8%	9.1%	11.9%
Higher	12	29	9	29	79
Higher	24%	38.2%	13.6%	37.7%	29.4%
Total	50	76	66	77	269

Completed	Sex		Total
Completed	Feminine	Masculine	Total
No	15	13	28
No	7.9%	16.2%	10.4%
Yes	174	67	241
Yes	92.1%	83.8%	89.6%
Total	189	80	269

	Sex		P
	Masculine	Feminine	P
Age (in years)	24.9	34.2	<0.0001
Age (in years)	10.5	10.7	<0.0001
Doses	3417.5	3664.0	0.03
Doses	1030.8	759.4	0.03
Number of applications	17.0	18.3	0.02
Number of applications	5.2	3.9	0.02
Time (in days)	43.6	45.2	0.56
Time (in days)	22.3	18.1	0.56

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[1] *Corresponding author: Balduino Ferreira de Menezes-Neto Unesp - Pronto Socorro Rua Doutor Adolfo Pardini Filho, 1028, Chácara Recreio Vista Alegre, Botucatu, SP, Brazil. CEP: 18608-760E-mail: balduinofmneto@gmail.com