Share This Article:

A Case for “Radiolysis” in Radiotherapy of Keloids

Full-Text HTML XML Download Download as PDF (Size:2875KB) PP. 226-234
DOI: 10.4236/ijmpcero.2014.34029    4,875 Downloads   5,389 Views  

ABSTRACT

Successful treatment of keloids has eluded the medical community since their first description. Multitudes of therapeutic options are available, but none achieves satisfactory resolution of keloids. One major stumbling block is lack of understanding about their genesis. Assuming keloids are tumors, attempts have been made to treat this condition with standard radiotherapy, with dismal results. Keloidal masses are not an active biological entity. They are aggregations of cellular, hypovascular, hypoxic bundles of collagen, which are produced by atypical fibroblasts in the wounds and eventually cease production due to a hostile biological environment. Having no demonstrable inherent process of disposal of these collagen bundles, this excessive collagen tends to linger to form the bulk of keloids. The lesions eventually become symptomatic and aesthetically unacceptable, and therapeutic intervention is sought. Of all available treatments, such as post-resection radiotherapy, primary radiotherapy in selected cases and primary brachytherapy stand out above any other form of treatment. Be it brachytherapy or external beam treatment, one fundamental aspect of radiation action is the process of “radiolysis”, explaining why “radiobiological” approaches have been ineffective.

Cite this paper

Malaker, K. , Weatherburn, H. and Souza, H. (2014) A Case for “Radiolysis” in Radiotherapy of Keloids. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 3, 226-234. doi: 10.4236/ijmpcero.2014.34029.

References

[1] Van Den Brenk, H.A.S. and Minty, C.C.J. (1960) Radiation in the Management of Keloids and Hypertrophic Scars. British Journal of Surgery, 47, 595-605.
http://dx.doi.org/10.1002/bjs.18004720603
[2] King, G.D. and Salzmann, F.A. (1970) Keloid Scars: Analysis of 89 Patients. Surgical Clinics of North America, 50, 595-598.
[3] Edsmyr, F., Larsson, L.G., Onyango, J., et al. (1974) Radiation Therapy in the Treatment of Keloids in East Africa. Acta Radiologica, 13, 102-106.
http://dx.doi.org/10.3109/02841867409129869
[4] Malaker, A., Ellis, F. and Paine, C.H. (1976) Keloid Scars: A New Method of Treatment of Combining Surgery with Interstitial Radiotherapy. Clinical Radiology, 2, 179-183.
http://dx.doi.org/10.1016/S0009-9260(76)80141-9
[5] Escarmant, P., Zimmerman, S., Amar, A., et al. (1993) The Treatment of 783 Keloid Scars by Iridium. 192 Interstitial Irradiation after Surgical Excision. International Journal of Radiation Oncology, Biology, Physics, 26, 245-251.
http://dx.doi.org/10.1016/0360-3016(93)90204-9
[6] Guix, B., Henriquez, I., Andres, A., et al. (2001) Treatment of Keloids by High-Dose-Rate Brachytherapy: A Seven Year Study. International Journal of Radiation Oncology, Biology, Physics, 50, 167-172.
http://dx.doi.org/10.1016/S0360-3016(00)01563-7
[7] Malaker, K., Vijayraghavan, K., Hodson, I. and Al Yafi, T. (2004) Retrospective Analysis of Treatment of Unresectable Keloids with Primary Radiation over 25 Years. Clinical Oncology, 16, 290-298.
http://dx.doi.org/10.1016/j.clon.2004.03.005
[8] Deka, B.C., Deka, A.C., Avadhani, J.S., et al. (1987) Treatment of Keloids with Strontium 90 Beta Rays. Indian Journal of Cancer, 24, 15-21.
[9] Belisario, J.C. (1957) The Treatment of Keloids. Acta Dermato-Venereologica, 37, 165-181.
[10] Vera, A., Weatherburn, H. and Malaker, K. (2013) A case of Post Varicella Recurrent Presternal Butterfly Keloid. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 2, 88-91.
http://dx.doi.org/10.4236/ijmpcero.2013.23012
[11] Ramakrishnan, K.M., Thomas, K.P. and Sundaranajan, C.R. (1974) Study of 1000 Patients with Keloid in South India. Plastic & Reconstructive Surgery, 53, 276-280.
http://dx.doi.org/10.1097/00006534-197403000-00004
[12] Van den Brenk, H.A. and Minty, C.C. (1960) Radiation in the Management of Keloids and Hypertrophic Scars. British Journal of Surgery, 47, 595-605.
http://dx.doi.org/10.1002/bjs.18004720603
[13] Inalsingh, C.H. (1974) An Experience in Treating Five Hundred and One Patients with Keloids. Johns Hopkins Medical Journal, 134, 284-290.
[14] Oluwasanmi, J.O. (1974) Keloids in the Africans. Clinics in Plastic Surgery, 1, 179-195.
[15] Cosman, B., Crikelair, G.F., Ju, M.C., Gaulin, J.C. and Lattes, R. (1961) The Surgical Treatment of Keloids. Plastic and Reconstructive Surgery, 27, 335-358.
[16] Chen, M.A., Davidson, T.M. and Terence, M. (2005) Scar Management: Prevention & Treatment Strategies. Current Opinion in Otolaryngology & Head & Neck Surgery, 13, 242-247.
http://dx.doi.org/10.1097/01.moo.0000170525.74264.f8
[17] Gangnani, A., Warde, M., Furtadu, F. and Ferreira, L.M. (2010) Topical Tamoxifen Therapy in Hypertrophic Scars or Keloids in Burns. Archives of Dermatological Research, 302, 1-4.
http://dx.doi.org/10.1007/s00403-009-0983-1
[18] Lee, Y, Minn, K.W., Baek, R.M. and Hong, J.J. (2001) A New Surgical Treatment of Keloids: Keloid Core Excision. Annals of Plastic Surgery, 46, 135-140.
http://dx.doi.org/10.1097/00000637-200102000-00008
[19] Donkor, P. (2007) Head and Neck Keloids: Treatment by Core Excision and Delayed Intralesional Injection of Steroid. Journal of Oral and Maxillofacial Surgery, 65, 1292-1296.
http://dx.doi.org/10.1016/j.joms.2006.10.049
[20] Sunohara, M., Ozawa, T., Harada, T., Morimoto, K. and Ishii, M. (2012) A Technique for Auricular Keloid Core Excision Using a Skin Biopsy Punch. Aesthetic Plastic Surgery, 36, 628-630.
http://dx.doi.org/10.1007/s00266-011-9858-x
[21] Druitt, R. and Joshua, B.F. (1844) The Principles and Practice of Modern Surgery. 3rd Edition, Lea and Blanchard, Philadelphia, London.
[22] Apfelberg, D.B., Maser, M.R. and Lash, H. (1976) The Use of Epidermis over a Keloid as an Autograph after Resection of the Keloid. The Journal of Dermatologic Surgery and Oncology, 2, 409-411.
http://dx.doi.org/10.1111/j.1524-4725.1976.tb00211.x
[23] Weimar, V.M. and Ceilley, R.I. (1979) Surgical Gems: Treatment of Keloids on Earlobes. The Journal of Dermatologic Surgery and Oncology, 5, 522-523.
http://dx.doi.org/10.1111/j.1524-4725.1979.tb00708.x
[24] Peacock, E.E. (1984) Wound Repair. W. B. Saunders, Philadelphia.
[25] Malaker, K. (2014) Keloid Prevention after Ear-Lobe Surgery. Middle East Scar Meeting Abst-SC4 March 2014, Dubai World Trade Center UAE, 44.
[26] Seegenschmiedt, M.H. and Strittmatter, H.J. (2008) Radiotherapy for Keloids and Hypertrophic Scars. MMW Fortschritte der Medizin, 150, 29-31.
[27] Brady, W.L. (2008) Radiotherapy for Non-Malignant Disorders. Springer Heidelberg, Berlin.
[28] Simmons, D.A. (1996) Patients with Keloids. Psychosocial Issues. Loss, Grief & Care, 7, 121-132.
http://dx.doi.org/10.1300/J132v07n03_11
[29] Bari, S., Choudhury, M.D. and Mahmud, I. (2001) Acid Burns in Bangladesh: Annals of Burn and Fire Disaster. XIV (3).
[30] Lawrence, W.T. (1991) In Search of the Optimal Treatment of Keloids: Report of a Series and a Review of the Literature. Annals of Plastic Surgery, 27, 164-178.
http://dx.doi.org/10.1097/00000637-199108000-00012
[31] Malaker, K., Vijayraghavan, K., Hodson, I. and Yafi, T. (2004) Retrospective Analysis of Treatment of Unresectable Keloids with Primary Radiation over 25 Years. Clinical Oncology, 16, 290-298.
http://dx.doi.org/10.1016/j.clon.2004.03.005
[32] Jeffry, M., Tyrone, J., Bonomo, S., Xia, Y. and Mustoe, T.A. (2000) Cellular Mechanisms for Diminished Scarring with Aging. Plastic and Reconstructive Surgery, 105, 1591-1599.
[33] Cohen, I.K., Diegelhann, R.F. and Kieser, H.R. (1976) Collagen Metabolism in Keloids and Hypertrophic Scars. In: Langacre, J.I., Ed., Ultrastructure of Collagen, Charles Thomas, Springfield, 199-212.
[34] Hall, E. and Giaccia, A.J. (2012) Linear Energy Transfer and Relative Biologic Effectiveness. In: Hall, E. and Giaccia, A., Eds., Radiobiology for the Radiologist, 7th Edition, Lippincott Williams & Wolters Kluwer, Philadelphia, 105-113.
[35] Hall, E. and Giaccia, A. (2012) Chapter 27 Chemotherapy Agents from the Perspective of the Radiation Biologist. In: Hall, E. and Giaccia, A., Eds., Radiobiology for the Radiologist, 7th Edition, Lippincott Williams & Wolters Kluwer, Philadelphia, 448-489.
[36] Williamson, J.F. and Brenner, D.J. (2008) Physics and Biology of Brachytherapy. In: Halprin, E.C., Perez, C.A. and Brady, L.W., Eds., Principles and Practice of Radiation Oncology, 5th Edition, Lippincott Williams and Wilkins, Philadelphia, 423-475.
[37] Overgaard, J. and Horsman, M.R. (1996) Modification of Hypoxia-Induced Radioresistance in Tumours by the Use of Oxygen and Sensitizers. Seminars in Radiation Oncology, 6, 10-21.
http://dx.doi.org/10.1016/S1053-4296(96)80032-4
[38] Hall, E. and Giaccia, A.J. (2012) Radioprotectors. In: Radiobiology for Radiologists, Lippincott Williams & Wilkin, Philadelphia, 129-134.
[39] Hall, E. and Giaccia, A.J. (2012) Chapter 23; Time Dose and Fractionation in Radiotherapy. In: Hall, E. and Giaccia, A., Eds., Radiobiology for the Radiologist, 7th Edition, Lippincott Williams & Wolters Kluwer, Philadelphia, 391-411.
[40] Fowler, J.F. (1989) The Linear-Quadratic Formula and Progress in Fractionated Radiotherapy. The British Journal of Radiology, 62, 679-694.
http://dx.doi.org/10.1259/0007-1285-62-740-679
[41] Yoshii, Y. (2008) Pathological Review of Late Cerebral Radionecrosis. Brain Tumour Pathology, 25, 51-58.
http://dx.doi.org/10.1007/s10014-008-0233-9
[42] Hall, E.J. and Giaccia, A.J. (2012) Linear Energy Transfer and Relative Biological Effectiveness. In: Radiobiology for the Radiologist, Lippincott Williams & Wolters Kluwer, Philadelphia, 104-113.
[43] Schneider, B.F., Eberhard, D.A. and Steiner, L.E. (1997) Histopathology of Arterio-Venous Malformations after Gamma Knife Radiosurgery. Journal of Neurosurgery, 87, 352-357.
http://dx.doi.org/10.3171/jns.1997.87.3.0352
[44] Hall, E.J. and Brenner, D.J. (1993) The Radiobiology of Radiosurgery: Rationale for Different Regimes for AVMs and Malignancies. International Journal of Radiation Oncology & Biology & Physics, 25, 381-385.
http://dx.doi.org/10.1016/0360-3016(93)90367-5
[45] Szeifert, G.T., Atterberry, D.S., Kondziolka, D., Levivier, M. and Lunsford, L.D. (2006) Cerebral Metastases Pathology after Radiosurgery—A Multicenter Study. Cancer, 106, 2672-2681.
http://dx.doi.org/10.1002/cncr.21946
[46] Monboisse, J.C., Gardès-Albert, M., Randoux, A., Borel, J.P. and Ferradini, C. (1988) Collagen Degradation by Super Oxide Anion in Pulse and Gamma Radiolysis. Biochimica et Biophysica Acta (BBA), General Subjects, 965, 29-35.
http://dx.doi.org/10.1016/0304-4165(88)90147-X
[47] Filali-Mouhim A., Audette, M., St. Louis, M., Thauvette, L., Denoroy, L., Penin, F., et al. (1997) Lysozyme Fragmentation Induced by Gamma-Radiolysis. International Journal of Radiation Biology, 72, 63-70.
http://dx.doi.org/10.1080/095530097143545
[48] Assemand, E., Lacroix, M., Mateescu, M.A. and Alexandru, M.L. (200) L-Tyrosine Prevents Aggregation of Therapeutic Proteins by γ-Irradiation. Biotechnology and Applied Biochemistry, 38, 151-156.
http://dx.doi.org/10.1042/BA20030038
[49] Schuessler, H. and Herget, A. (1980) Oxygen Effect in the Radiolysis of Proteins I. Lactate Dehydrogenase. International Journal of Radiation Biology, 37, 71-80.
http://dx.doi.org/10.1080/09553008014550071
[50] Schuessler, H. and Schilling, K. (1984) Oxygen Effect in Radiolysis of Proteins Part II, Bovine Serum Albumin. International Journal of Radiation Biology & Related Studies in Physics, Chemistry & Medicine, 45, 267-268.
[51] Sloan, D.F., Brown, D. and Wells, C.H. (1978) Tissue Gases in Human Hypertrophic Burn Scars. Plastic & Reconstructive Surgery, 61, 431-435.
[52] Kischer, C.W., Thies, A.C. and Chapil, M. (1982) Perivascular Myofibroblasts and Microvascular Occlusion in Hypertrophic Scars and Keloids. Human Pathology, 13, 819-824.
http://dx.doi.org/10.1016/S0046-8177(82)80078-6
[53] Sahl, W.J. and Clever, H. (1994) Cutaneous Scars Part II. International Journal of Dermatology, 33, 763-769.
http://dx.doi.org/10.1111/j.1365-4362.1994.tb00984.x
[54] Lee, Y.Y., Yang, C.C., Chao, S.C. and Wong, T.W. (2004) Histopathological Differential Diagnosis of Keloid and Hypertrophic Scars. American Journal of Dermatopathology, 26, 379-384.
http://dx.doi.org/10.1097/00000372-200410000-00006
[55] Kischer, C.W. (1992) The Microvessels in Hypertrophic Scars, Keloids and Related Lesions: A Review. Journal of Submicroscopic Cytology and Pathology, 24, 281-296.
[56] Leventhal, D., Furr, M. and Reiter, D. (2006) Treatment of Keloids and Hypertrophic Scars: A Meta-Analysis and Review of the Literature. Archives of Facial Plastic Surgery, 8, 362-368.
http://dx.doi.org/10.1001/archfaci.8.6.362
[57] Order, S.E. and Donaldson, S.S. (1982) Radiation Therapy of Benign Diseases. A Clinical Guide. 2nd Edition, Springer, Berlin, 182.
[58] Zuber, T.J. and DeWitt, D.E. (1994) Earlobe Keloids. American Family Physician, 49, 1835-1841.
[59] Music, E. and Engel, G. (2010) Earlobe Keloids: A Novel and Elegant Surgical Approach. Dermatologic Surgery, 36, 395-400.
http://dx.doi.org/10.1111/j.1524-4725.2009.01452.x
[60] Zhang, Y., Cen, Y., Liu, X., Yu, R. and Xu, X.W. (2009) Clinical Improvement in the Therapy of Aural Keloids. Chinese Medical Journal, 122, 2865-2868.
[61] Flickinger, J.C. (2014) A Radiobiological Analysis of Multicenter Data for Postoperative Keloid Radiotherapy. International Journal of Radiation Oncology & Biology & Physics, 79, 1164-1170.
http://dx.doi.org/10.1016/j.ijrobp.2009.12.019

  
comments powered by Disqus

Copyright © 2017 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.