107例瘢痕疙瘩术后两种分割剂量放疗疗效分析

摘要/Abstract

摘要： 目的：分析两种放疗分割方式对预防瘢痕疙瘩术后复发的疗效，探讨瘢痕疙瘩术后放疗的最佳方式。方法：北京大学第一医院放射治疗科自2011年8月至2012年10月对瘢痕疙瘩患者术后24 h内开始放疗，并采取两种放疗分割方式治疗：每天1次5 Gy照射，连续4 d（5 Gy组）；每天1次4 Gy照射，连续5 d（4 Gy组）。共治疗107例患者的139个病变，为使材料更具可比性，在同患者同部位出现多个病变时，仅取一个最大病变进行疗效分析，最终纳入114个病变。参考Darzi的瘢痕疙瘩疗效标准将疗效分为治愈、好转、无效，有效为治愈与好转之和，复发指放疗无效患者。采用SPSS 14.0软件进行统计学处理和分析。结果：总有效率5 Gy组为90.7%（49/54），4 Gy组为66.7%（40/60），两组差异有统计学意义（P=0.001）。将病变部位按皮肤张力大小分为耳部面颈区、前胸肩背区、其他部位进一步分析，5 Gy组及4 Gy组的疗效分别为94.1% 和85.0%（P=0.609）、89.7%和60.0%（P=0.009）、87.5%和50.0%（P=0.152），前胸肩背区5 Gy组疗效明显优于4 Gy组。两组的放疗副作用均不明显。结论：瘢痕疙瘩术后24 h内开始放疗，每天治疗1次，每次给予5 Gy（连续4 d）或4 Gy（连续5 d）均是有效的，特别是每次5 Gy（连续4 d）的放疗效果更好，提示大分割短疗程的放疗效果更好，对患者也更加经济方便，值得进一步探讨。

关键词: 瘢痕疙瘩, 放射治疗剂量, 放射剂量分次, 治疗结果

Abstract: Objective：To observe the preventive effect of two fractionations for postoperative radiotherapy of keloid and discuss the optimal way for postoperative radiotherapy. Methods: We enrolled 107 consecutive keloid patients with 139 lesions from August 2011 to October 2012 in Department of Radiation Oncology of Peking University First Hospital. There were 114 lesions (the largest lesion part will be accounted if there are several lesions in the single body area) into the curative effect of the statistics. All the patients received irradiation after operation within 24 hours. The patients were divided into two groups: 5 Gy/f for continuous 4 days (5 Gy group); 4 Gy/f for continuous 5 days (4 Gy group). The lesions were treated by 6 MeV-E by Varian 21EX medical linear accelerator made in America. The irradiation field was surgical incision plus 1 cm in radial directions. One centimeter bolus was put on the skin to attain the therapeutical dose of skin surface. The total dose for each lesion was 20 Gy. The treatment effect of keloid was classified into cure, excellence and recurrence, referring to Darzi’s standard. Effectivity means the sum of cure and excellence. SPSS 14.0 was used to statistically analyze the data. Results: The total effective rate for 5 Gy group was 90.7% (49/54) and 66.7% (40/60) for 4 Gy group (P=0.001). The lesions were divided into three regions according to the tension of the skin: ear/face/neck region, chest wall/shoulder/back region and other regions. The treatment effects of 5 Gy group and 4 Gy group were 94.1% (16/17) vs. 85.0% (17/20) for ear/face/neck region, 89.7% (26/29) vs. 60.0% (18/30) for chest wall/shoulder/back region and 87.5% (7/8) vs. 50.0% (5/10) for other regions. Significant difference was found in chest wall/shoulder/back region (P=0.009). No obvious toxicities occurred in any group. Conclusion: Postoperative radiation therapy within 24 hours of 5 Gy/f for continuous 4 days and 4 Gy/f for continuous 5 days is effective, especially in 5 Gy/f group. It is suggested that hypofractionated radiation therapy is more effective for keloid patients, and it is also economical and convenient for patients and worth further discussing.

Key words: Keloid, Radiotherapy dosage, Dose fractionation, Treatment outcome

王庆国，李晓梅，张敏，李航，温冰，李洪振，高献书. 107例瘢痕疙瘩术后两种分割剂量放疗疗效分析[J]. 北京大学学报（医学版）, 2014, 46(1): 169-172.

WANG Qing-guo, LI Xiao-mei, ZHANG Min, LI Hang, WEN Bing, LI Hong-zhen, GAO Xian-shu. Effect of two dose fractionations on postoperative radiotherapy of keloid: an analysis of 107 patients[J]. Journal of Peking University(Health Sciences), 2014, 46(1): 169-172.

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