Concurrent Multi-Modality Treatment of Keloids (CMTK) Not Manageable by Conventional Postoperative Radiotherapy


Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective cohort study. Setting: Two major postgraduate teaching hospitals: one in Tripoli, Libya and the other in Jeddah, Saudi Arabia. Participants: Fifty-seven patients with 79 keloids, referred from Plastic Surgery Units between April 1996 and January 2005. Main Outcome Measure: Degree of flattening of the keloidal lesion and symptomatic recovery. Results: Result of treatment has been analyzed using unified set criteria. Seventy-seven percent of this cohort had complete response. 19% of cases had partial response, 50% acknowledged the treatment outcome had been “satisfactory” and 44% had an “acceptable” outcome. There was no significant acute or delayed reaction. Conclusion: The technique appears universally adaptable, cost effective, and can safely be prescribed for children and women of child-bearing age. In spite of prolonged treatment course, compliance was excellent.

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K. Malaker, M. Zaidi, M. Franka and T. Yafi, "Concurrent Multi-Modality Treatment of Keloids (CMTK) Not Manageable by Conventional Postoperative Radiotherapy," International Journal of Clinical Medicine, Vol. 4 No. 5, 2013, pp. 273-281. doi: 10.4236/ijcm.2013.45048.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. Anderson and B. M. Branner, “Progressive Renal Disease: A Disorder of Adaptation,” Quarterly Journal of Medicine, Vol. 70, No. 263, 1989, pp. 185-189.
[2] P. Rubin, A. Soni and J. P. Williams, “The Molecular and Cellular Biologic Basis for the Radiation Treatment of Benign Proliferative Disease,” Seminars in Radiation Oncology, Vol. 9, No. 2, 1999, pp. 203-214. doi:10.1016/S1053-4296(99)80010-1
[3] A. E. Brissett and D. A. Sherris, “Scar Contractures, Hypertrophic Scars, and Keloids,” Facial Plastic Surgery, Vol. 17, No. 4, 2001, pp. 263-272. doi:10.1055/s-2001-18827
[4] W. G. Payne, F. Ko, S. Anspaugh, et al., “Down-Regulating Causes of Fibrosis with Tamoxifen: A Possible Cellular/Molecular Approach to Treat Rhinophyma,” Annals of Plastic Surgery, Vol. 56, No. 3, 2006, pp. 301305. doi:10.1097/
[5] H. Tamai, O. Katoh, S. Suzuki, et al., “Impact of Tranilast on Restenosis after Coronary Angioplasty: Tranilast Restensosis Following Angioplasty Trial (TREAT),” American Heart Journal, Vol. 138, No. 5, 1999, pp. 968-975. doi:10.1016/S0002-8703(99)70025-6
[6] G. Muneuchi, S. Suzuki, M. Onodera, O. Ito, Y. Hata and H. H. Igawa, “Long-Term Outcome of Intralesional Injection of Triamcinolone Acetonide for the Treatment of Keloid Scars in Asian Patients,” Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, Vol. 40, No. 2, 2006, pp. 111-116. doi:10.1080/02844310500430003
[7] G. G. Gauglitz, H. C. Korting, T. Pavicic, et al., “Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies,” Molecular Medicine, Vol. 17, No. 1-2, 2011, pp. 113-125. doi:10.2119/molmed.2009.00153
[8] S. Mutalik, “Treatment of Keloids and Hypertrophic Scars,” Indian Journal of Dermatology, Venereology and Leprology, Vol. 71, No. 1, 2005, pp. 3-8. doi:10.4103/0378-6323.13777
[9] A. Goel and P. Shrivastava, “Post-Burn Scars and Scar Contractures,” Indian Journal of Plastic Surgery, Vol. 43, 2010, pp. S63-S71. doi:10.4103/0970-0358.70724
[10] B. Berman and H. C. Bieley, “Keloids,” Journal of the American Academy of Dermatology, Vol. 33, No. 1, 1995, pp. 117-123. doi:10.1016/0190-9622(95)90035-7
[11] T. S. Alster and E. L. Tanzi, “Hypertrophic Scars and Keloids: Etiology and Management,” American Journal of Clinical Dermatology, Vol. 4, No. 4, 2003, pp. 235243. doi:10.2165/00128071-200304040-00003
[12] G. L. Dockery and R. Z. Nilson, “Treatment of Hypertrophic and Keloid Scars with Silastic Gel Sheeting,” Journal of Foot and Ankle Surgery, Vol. 33, No. 2, 1994, pp. 110-119.
[13] K. Perkins, R. B. Davey and K. A. Wallis, “Silicone Gel: A New Treatment for Burn Scars and Contractures,” Burns, Including Thermal Injury, Vol. 9, No. 3, 1983, pp. 201-204. doi:10.1016/0305-4179(83)90039-6
[14] M. Gibbons, R. Zuker, M. Brown, et al., “Experience with Silastic Gel Sheeting in Pediatric Scarring,” Journal of Burn Care & Rehabilitation, Vol. 15, No. 1, 1994, pp. 69-73. doi:10.1097/00004630-199401000-00013
[15] B. Hirshowitz, E. Lindenbaum, Y. Har-Shai, et al., “Static-Electric Field Induction by a Silicone Cushion for the Treatment of Hypertrophic and Keloid Scars,” Plastic and Reconstructive Surgery, Vol. 101, No. 5, 1998, pp. 11731183.
[16] L. Narkwong and P. Thirakhupt, “Postoperative Radiotherapy with High Dose Rate Iridium 192 Mould for Prevention of Earlobe Keloids,” Journal of the Medical Association of Thailand, Vol. 89, No. 4, 2006, pp. 428-433.
[17] E. Willich, H. Kuttig, G. Pfeil, et al., “Pathological Changes (Developmental/Growth Disturbances) of the Spine after Radiation Therapy of Nephroblastomas during Early Childhood. A Retrospective Long-Term Follow-Up Study in 82 Children,” Strahlentherapie und Onkologie, Vol. 166, 1990, pp. 815-821.
[18] D. L. Preston, A. Mattsson, E. Holmberg, et al., “Radiation Effects on Breast Cancer Risk: A Pooled Analysis of Eight Cohorts,” Radiation Research, Vol. 158, No. 2, 2002, pp. 220-235. doi:10.1667/0033-7587(2002)158[0220:REOBCR]2.0.CO;2
[19] F. Nguyen, C. Rubino, S. Guerin, et al., “Risk of a Second Malignant Neoplasm after Cancer in Childhood Treated with Radiotherapy: Correlation with the Integral Dose Restricted to the Irradiated Fields,” International Journal of Radiation Oncology Biology Physics, Vol. 70, No. 3, 2008, pp. 908-915. doi:10.1016/j.ijrobp.2007.10.034
[20] T. A. Mustoe, “Evolution of Silicone Therapy and Mechanism of Action in Scar Management,” Aesthetic Plastic Surgery, Vol. 32, No. 1, 2008, pp. 82-92. doi:10.1007/s00266-007-9030-9
[21] P. W. Grigsby, A. Russel, D. Bruner, et al., “Late Injury of Cancer Therapy on the Female Reproductive Tract,” International Journal of Radiation Oncol-ogy Biology Physics, Vol. 31, No. 5, 1995, pp. 1281-1299. doi:10.1016/0360-3016(94)00426-L
[22] C. W. Kischer, M. R. Shetlar and M. Chvapil, “Hypertrophic Scars and Keloids: A Review and New Concept Concerning Their Origin,” Scanning Electron Microscopy, Vol. 4, 1982, pp. 1699-1713.
[23] D. Deveci, J. M. Marshall and S. Egginton, “Chronic Hypoxia Induces Prolonged Angiogenesis in Skeletal Muscles of Rat,” Experimental Physiology, Vol. 87, No. 3, 2002, pp. 287-291. doi:10.1113/eph8702377
[24] B. Liu and M. K. Connolly, “The Pathogenesis of Cutaneous Fibrosis,” Seminars in Cutaneous Medicine and Surgery, Vol. 17, No. 1, 1998, pp. 3-11. doi:10.1016/S1085-5629(98)80055-2
[25] C. T. Taylor and S. P. Colgan, “Therapeutic Targets for Hypoxia-Elicited Pathways,” Pharmaceutical Research, Vol. 16, No. 10, 1999, pp. 1498-1505. doi:10.1023/A:1011936016833
[26] P. Martin, “Wound Healing—Aiming for Perfect Skin Regeneration,” Science, Vol. 276, No. 5309, 1997, pp. 75-81. doi:10.1126/science.276.5309.75
[27] M. G. Traber and L. Packer, “Vitamin E: Beyond Antioxidant Function,” The American Journal of Clinical Nutrition, Vol. 62, No. 6, 1995, pp. 1501S-1509S.
[28] S. Khanna, S. Roy, H. Ryu, P. Bahadduri, P. W. Swaan, R. R. Ratan and C. K. Sen, “Molecular Basis of Vitamin E Action. Tocotrienol Modulates 12-Lipoxygenase, a Key Mediator of Glutamate-Induced Neurodegeneration,” The Journal of Biological Chemistry, Vol. 278, No. 44, 2003, pp. 43508-43515. doi:10.1074/jbc.M307075200
[29] L. Ernster, P. Forsmark and K. Nordenbrand, “The Mode of Action of Lipid-Soluble Antioxidants in Biological Membranes: Relationship between the Effects of Ubiquinol and Vitamin E as Inhibitors of Lipid Peroxidation in Submitochondrial Particles,” Biofactors, Vol. 3, No. 4, 1992, pp. 241-248.
[30] V. Jones, J. E. Grey and K. G. Harding, “ABC of Wound Healing: Wound Dressings,” British Medical Journal, Vol. 332, No. 7544, 2006, pp. 777-780. doi:10.1136/bmj.332.7544.777
[31] K. Malaker, K. Vijayraghavan, I. Hodson and T. Al Yafi, “Retrospective Analysis of Treatment of Unresectable Keloids with Primary Radiation over 25 Years,” Clinical Oncology (Royal College of Radiologists), Vol. 16, No. 4, 2004, pp. 290-298. doi:10.1016/j.clon.2004.03.005
[32] T. S. Alster and T. B. West, “Treatment of Scars: A Review,” Annals of Plastic Surgery, Vol. 39, No. 4, 1997, pp. 418-432. doi:10.1097/00000637-199710000-00014
[33] B. J. Moeller, Y. Cao, Z. Vujaskovic, C. Y. Li, Z. A. Haroon and M. W. Dewhirst, “The Relationship between Hypoxia and Angiogenesis,” Seminars in Radiation Oncology, Vol. 14, No. 3, 2004, pp. 215-221. doi:10.1016/j.semradonc.2004.04.005
[34] C. W. Pugh and P. J. Ratcliffe, “Regulation of Angiogenesis by Hypoxia: Role of the HIF System,” Nature Medicine, Vol. 9, No. 6, 2003, pp. 677-684. doi:10.1038/nm0603-677
[35] J. M. Gleadle, B. L. Ebert, J. D. Firth and P. J. Ratcliffe, “Regulation of Angiogenic Growth Factor Expression by Hypoxia, Transition Metals, and Chelating Agents,” American Journal of Physiology, Vol. 268, No. 6, 1995, pp. C1362-C1368.
[36] J. T. Norman, I. M. Clark and P. L. Garcia, “Hypoxia Promotes Fibrogenesis in Human Renal Fibroblasts,” Kidney International, Vol. 58, No. 6, 2000, pp. 23512366. doi:10.1046/j.1523-1755.2000.00419.x
[37] Y. Ganat, S. Soni, M. Chacon, M. L. Schwartz and F. M. Vaccarino, “Chronic Hypoxia Up-Regulates Fibroblast Growth Factor Ligands in the Perinatal Brain and Induces Fibroblast Growth Factor-Responsive Radial Glial Cells in the Sub-Ependymal Zone,” Neuroscience, Vol. 112, No. 4, 2002, pp. 977-991. doi:10.1016/S0306-4522(02)00060-X
[38] A. P. Kelly, “Medical and Surgical Therapies for Keloids,” Dermatology and Therapy, Vol. 17, No. 2, 2004, pp. 212-218. doi:10.1111/j.1396-0296.2004.04022.x
[39] Q. Dinh, M. Veness and S. Richards, “Role of Adjuvant Radiotherapy in Recurrent Earlobe Keloids,” Australasian Journal of Dermatology, Vol. 45, No. 3, 2004, pp. 162-166. doi:10.1111/j.1440-0960.2004.00079.x
[40] E. E. Tredget, B. Nedelec, P. G. Scott and A. Ghahary, “Hypertrophic Scars, Keloids, and Contractures. The Cellular and Molecular Basis for Therapy,” Surgical Clinics of North America, Vol. 77, No. 3, 1997, pp. 701-730. doi:10.1016/S0039-6109(05)70576-4

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