Comparison Of The Efficacy Between Conventional Radiotherapy And Hypofractionated Radiotherapy For Postoperative Radiotherapy In Keloids

Objective: To observe the related factors of clinical efficacy,adverse reaction and recurrence by hypofractionated radiotherapy and conventional fractionation for postoperative electron beam radiotherapy in the treatment of keloids,and explore the optimal radiotherapy fractionation and dose for postoperative radiotherapy, so as to provide clinical basis for postoperative radiotherapy.Method: From 2006 to 2012, we collected 99 patients with keloid in department of radiotherapy of the Second Affiliated Hospital of Dalian Medical University,the patients were treated by surgical removal combined with postoperative radiotherapy within 24 hours.We used 6 Me V electron beam radiotherapy,and the patients were divided into two groups according to radiation dose,36 patients were treated in 4 Gy group,the total dose was 16 Gy,4 Gy/f for continuous 4 days;63 patients were treated in 2 Gy group,the total dose was 20 Gy, 2 Gy/f for 10 days,5 times a week.Monthly outpatient follow-up during radiotherapy and after radiotherapy in half a year. Every 3 months using outpatient or telephone visit follow-up after radiotherapy in six months, all patients were followed up more than 12 months, the median follow-up period was 18 months. At 12 th month follow-up time, evaluate the clinical curative effect, early toxicity outcomes of radiotherapy, late toxicity outcomes of radiotherapy, and analysis the correlation between curative effect of radiotherapy and the influencing factors, such as interval after operation, size of lesion area, location,and gender.Result: 1. In twelfth month, the total effective rate for 4 Gy group were 83.3% vs65.1% for group 2 Gy group(x2=3.763, P=0.052),the difference had no statistical significance.2. To compare the radiotherapy curative effect of the lesion in each group, the treatment effect of chest wall/shoulder/back region rank the lowest of all lesions. The difference of radiotherapy curative effect of each lesion of 4 Gy group had no statistical significance(x2=0.903, P=0.737). For 2 Gy group, the difference had statistical significance,(x2=6.568, P=0.037), it is considered that the lesion affect the efficacy of radiotherapy. To compare the efficacy of radiotherapy of the lesion respectively,the lesion including the following regions: ear/neck and face region,chest wall/shoulder/back region and other regions. Between the two groups,significant difference was found in the efficiency for 4 Gy group and 2 Gy group in the region of chest wall/shoulder/back were 78.9% vs. 51.4%(x2=3.924,P=0.048),the rest of the region had no statistical significance.3. To compare the radiotherapy curative effect of gender in each group, the treatment effects of male in the two groups were78.6% vs. 61.1%,(x2=0.453,P=0.501), the difference had no statistical significance. The effective rate of female in the two groups were 86.3% vs. 66.7%(x2=2.918,P=0.088), the difference had no statistical significance.4. To compare the radiotherapy curative effect of interval after operation in each group(within 4 h and within 24 h), the effective rate for 4 Gy group and 2 Gy group within 4 h were 92.8% vs. 72.7%(x2=1.328,P=0.249), the difference had no statistical significance. The effective rate for 4 Gy group and 2 Gy group within 24 h were 77.3% vs. 56.7%(x2=0.238,P=0.123),the difference had no statistical significance.5. To compare the radiotherapy curative effect of the size of the lesion area in each group. When keloid size≤5 cm2, statistical significance was not found, the effective rate for 4 Gy group and 2 Gy group were 87.5% vs. 71.4%(x2=0.874,P=0.350).When keloid size>5 cm2, the effective rate for 4 Gy group and 2 Gy group were80.0% vs. 52.4%(x2=3.475,P=0.062), the difference had no statistical significance.6. The incidence of early adverse reactions of radiotherapy of 4 Gy group and 2 Gy group were 80.6% vs 61.9% respectively(x2=3.705,P=0.054), the difference had no statistical significance. The incidence of long-term adverse reactions of radiotherapy of 4 Gy group and 2 Gy group were 30.6% vs. 20.6%( x 2=1.228,P=0.268), the difference had no statistical significance.7. The satisfaction of patients for 4 Gy group was 77.8% and 71.4% for 2 Gy group(x2=3.20,P=0.074), the difference had no statistical significance.Conclusion: 1. Postoperative electron beam radiotherapy is a safe and effective treatment in keloid, The curative effect of hypofractionated radiotherapy is equal to conventional fractionation for postoperative radiotherapy of keloid, the hypofractionated radiatherapy group could shorten the treatment time and save the medical expenses, thus it is recommended clinical application under the premise of ensure clinical curative effeciency.2. The location of lesion was correlated to the efficiency of hypofractionated and conventional fractionation postoperative radiotherapy, but not with gender, size of lesions and interval after operation(within 4 h and within 24 h).3. The early adverse reactions and long-term adverse reactions of radiotherapy and satisfaction of patients in the two groups had no difference.