耳部蟹足腫手術切除合併術後放射治療

Radiation Therapy for Ear Keloids after Surgical Excision

曾鐘毅(Chung-Yi Tseng) ； 程言鼎(Yen-Ting Cheng) ； 陳臣苑(Chen-Yuan Chen) ； 蔡宜君(Yi-Chun Tsai) ； 王軒庭(Hsuan-Ting Wang) ； 陳柏元(Po-Yuan Chen) ； 林士敏(Shih-Min Lin)

《中華放射線技術學雜誌》 43卷2期 (2019/06) Pp. 77-83

摘要

瘢痕疙瘩（Keloids），又稱作蟹足腫，常見於手術後傷口或是創傷後傷口，是一種皮膚創傷面癒合後，局部組織過度纖維化並超出原傷口邊緣向周圍正常皮膚生長的皮膚疾病。耳垂與耳廓是蟹足腫的好發部位，通常在耳洞穿刺或創傷後約有2.5%的發病機率，但臨床上單獨手術切除蟹足腫被認為是一種無效的治療方法，因其復發率為45－100%。手術切除合併術後放射治療，提供了一種不錯的治療組合，但放射治療時輻射劑量與分期的方案，並沒有一個統一的標準答案，本文報導了我們對於蟹足腫治療的經驗，分享耳垂與耳廓的蟹足腫在手術切除後的放射治療其方式與配件，並觀察相關的臨床結果及周邊散射劑量。七位患者皆在手術切除後24小時內接受放射治療，治療使用6MeV電子射線給予處方劑量15Gy分期三次的放射治療，治療前病灶區周邊放置光激發光劑量計（OSLD），測量並觀察其照野外周邊之散射劑量。後續追蹤目前沒有任何患者復發，並且沒有觀察到嚴重的不良反應，在散射劑量的量測上也顯示在固定患者的姿勢上有良好的再現性。臨床實務上，我們仍建議放射治療應用於其他的替代療法都失敗的蟹足腫復發案例，以降低因機率效應誘發的繼發性癌症。

關鍵字

蟹足腫 ； 放射治療 ； 光激發光劑量計

並列摘要

Keloids, also known as ＂crab's claw＂, were observed in healed wounds especially after operation or deep trauma. There is excessively fibrotic tissue formation and even continuously growing beyond the original wound edge in keloid lesions. Earlobes and ear auricle are common sites for keloid formation with an incidence of approximately 2.5 percent after ear piercing or trauma. Surgical excision alone for the treatments of keloids is considered to be an ineffective treatment due to high recurrence rate up to 45-100%. Surgical excision combined with radiation therapy was recognized as one of fair treatment strategies, but there is no consensus on the optimal radiation dose and fractionation schedule. This article reported our experiences about the keloids treatments, and shared the details of setup methods and radiotherapy regimens for keloids at earlobe and ear auricle after surgical excision. We also reported the clinical results and the observed peripheral scattering dose. Seven patients underwent radiotherapy within 24 hours after surgical excision. Keloids were irradiated with a 6-MeV electron beam of 15 Gy in 3 fractions. The optical stimulated luminescence dosimeter (OSLD) was placed around the irradiation area before treatment, and surrounding scattering dose was measured and observed. There was no recurrence in any of the patients, nor severe adverse effects observed. The measurement of the scattered dose also showed the high reproducibility on patients’ fixation. In clinical practice, we recommend that radiotherapy should be reserved for those recurrent keloids to minimize the incidence of secondary malignancy observed by stochastic effects.

並列關鍵字

Keloid ； Radiotherapy ； OSLD