scholarly journals The use of chemotherapeutics for the treatment of keloid scars

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Christopher David Jones ◽  
Luke Guiot ◽  
Mike Samy ◽  
Mark Gorman ◽  
Hamid Tehrani
Keyword(s):  
Mitomycin C ◽  
Steroid Injection ◽  
Combined Therapy ◽  
Surgical Excision ◽  
Chemotherapeutic Agents ◽  
Treatment Modalities ◽  
Success Rates ◽  
Recurrence Rates ◽  
Cutaneous Injury ◽  
Keloid Scars

Keloid scars are pathological scars, which develop as a result of exaggerated dermal tissue proliferation following cutaneous injury and often cause physical, psychological and cosmetic problems. Various theories regarding keloidogenesis exist, however the precise pathophysiological events remain unclear. Many different treatment modalities have been implicated in their management, but currently there is no entirely satisfactory method for treating all keloid lesions. We review a number of different chemotherapeutic agents which have been proposed for the treatment of keloid and hypertrophic scars while giving insight into some of the novel chemotherapeutic drugs which are currently being investigated. Non-randomized trials evaluating the influence of different chemotherapeutic agents, such as 5-fluorouracil (5-FU); mitomycin C; bleomycin and steroid injection, either alone or in combination with other chemotherapeutic agents or alternative treatment modalities, for the treatment of keloids were identified using a predefined PubMed search strategy. Twenty seven papers were identified. Scar improvement ≥50% was found in the majority of cases treated with 5-FU, with similar results found for mitomycin C, bleomycin and steroid injection. Combined intralesional 5-FU and steroid injection produced statistically significant improvements when compared to monotherapy. Monotherapy recurrence rates ranged from 0-47% for 5-FU, 0-15% for bleomycin and 0-50% for steroid injection. However, combined therapy in the form of surgical excision and adjuvant 5-FU or steroid injections demonstrated lower recurrence rates; 19% and 6% respectively. Currently, most of the literature supports the use of combination therapy (usually surgery and adjuvant chemotherapy) as the mainstay treatment of keloids, however further investigation is necessary to determine success rates over longer time frames. Furthermore, there is the potential for novel therapies, but further investigation is required to elucidate their true efficacy.

Hyperthermia Improves Solubility of Intravesical Chemotherapeutic Agents

2020 ◽  
Vol 6 (4) ◽  
pp. 461-470
Author(s):  
Dominic C. Grimberg ◽  
Ankeet Shah ◽  
Wei Phin Tan ◽  
Wiguins Etienne ◽  
Ivan Spasojevic ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Mitomycin C ◽  
Room Temperature ◽  
Chemotherapeutic Agents ◽  
Intravesical Chemotherapy ◽  
Response To Treatment ◽  
Intravesical Therapy ◽  
Recurrence Rates ◽  
Urine Ph ◽  
Improve Drug Delivery

BACKGROUND: Nearly 70% of all new cases of bladder cancer are non-muscle invasive disease, the treatment for which includes transurethral resection followed by intravesical therapy. Unfortunately, recurrence rates approach 50% in part due to poor intravesical drug delivery. Hyperthermia is frequently used as an adjunct to intravesical chemotherapy to improve drug delivery and response to treatment. OBJECTIVE: To assess the solubility profile of intravesical chemotherapies under varying conditions of pH and temperature. METHODS: Using microplate laser nephelometry we measured the solubility of three intravesical chemotherapy agents (mitomycin C, gemcitabine, and cisplatin) at varying physical conditions. Drugs were assessed at room temperature (23°C), body temperature (37°C), and 43°C, the temperature used for hyperthermic intravesical treatments. To account for variations in urine pH, solubility was also investigated at pH 4.00, 6.00, and 8.00. RESULTS: Heat incrementally increased the solubility of all three drugs studied. Conversely, pH largely did not impact solubility aside for gemcitabine which showed slightly reduced solubility at pH 8.00 versus 6.00 or 4.00. Mitomycin C at the commonly used 2.0 mg/mL was insoluble at room temperature, but soluble at both 37 and 43°C. CONCLUSIONS: Hyperthermia as an adjunct to intravesical treatment would improve drug solubility, and likely drug delivery as some current regimens are insoluble without heat. Improvements in solubility also allow for testing of alternative administration regimens to improve drug delivery or tolerability. Further studies are needed to confirm that improvements in solubility result in increased drug delivery.

Topical Therapy for Ocular Surface Squamous Neoplasia

2013 ◽  
Vol 06 (02) ◽  
pp. 154
Author(s):  
Derek Bitner ◽  
Donald U Stone ◽  
◽  
Keyword(s):  
Ocular Surface ◽  
Topical Therapy ◽  
Genetic Defect ◽  
Surgical Excision ◽  
Treatment Modalities ◽  
Ocular Surface Squamous Neoplasia ◽  
Recurrence Rates ◽  
Interferon Alpha 2B ◽  
Complete Surgical Excision ◽  
Treatment Paradigm

Ocular surface squamous neoplasia, or OSSN, is a clinical spectrum often encountered in ophthalmic practice. The incidence varies depending on the population being studied, but is more common among less pigmented males with increased occupational ultraviolet (UV) exposure as well as among those living in closer proximity to the equator. The incidence increases with age; in younger patients, the presence of OSSN is often associated with another underlying disorder, such as the genetic defect in xeroderma pigmentosum, or immunosuppression as is seen in patients infected with HIV. The challenges of complete surgical excision in patients with extensive tumors, in addition to the high recurrence rates in some series, led to a search for nonsurgical treatment modalities. In addition to avoiding surgery, topical agents may offer the additional benefit of treating clinically unapparent disease. Due to the theoretic advantages of topical chemotherapy, multiple agents have been used in both the primary and adjuvant treatment of OSSN. Mitomycin, interferon alpha-2b, and 5-fluorouracil have all been utilized with success; mitomycin may invoke a greater risk for limbal stem cell failure, and interferon is well tolerated and effective but more expensive. Future developments in imaging and chemotherapeutics will likely continue to alter the treatment paradigm for ocular surface tumors.

scholarly journals The Efficacy of Local Application of Mitomycin C in Reducing Recurrence Rate of Keloid after Surgery

2016 ◽  
Vol 24 (3) ◽  
pp. 117-121
Author(s):  
Anindita Sengupta ◽  
Arindam Das ◽  
Debasish Ghosh ◽  
Subhadip Dhara ◽  
Soumyendu Ghosh ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Mitomycin C ◽  
Topical Application ◽  
Previous History ◽  
Surgical Excision ◽  
Recurrence Rates ◽  
History Of ◽  
Study Population ◽  
Group 2 ◽  
Group 1

Introduction  Keloid is a hyperproliferative response of the fibroelastic connective tissue to dermal trauma, appearing predominantly in areas of high skin tension. Surgical excision produces immediate cosmetic correction, but recurrence rates after surgical treatment alone are high and post excision adjunct therapies should be considered. Topical application of Mitomycin C has shown to suppress cell division, fibroblast proliferation, protein and collagen synthesis and angiogenesis. In our study we applied it locally after surgical excision of keloid of auricle and compared the outcome with post-surgical perilesional Triamcinolone acetonide injection to reduce recurrence. Materials and Method Fifty cases with primary or recurrent keloid over auricle were studied from February 2015 to January 2016. They are divided into two groups; Group 1 received local Mitomycin C application after keloid excision while Group 2 had perilesional injection of Triamcinolone acetonide after surgical excision of keloid. The results were compared 6 months after the initial treatment. Result  There was no statistical difference in the baseline characteristics like age, sex, type of symptoms and previous history of recurrence between the two groups. Most of the patients in both the groups were aged between 14 and 30 years. The study population constituted predominantly of females. At the end of 6 months follow up, the recurrences noted were 5 and 6 respectively in Group 1 and 2 out of 25 patients in each group. Conclusion After surgical excision of keloid, topical application of Mitomycin C is as effective as intralesional Triamcinolone acetonide injection in terms of recurrence of the keloids affecting the auricle.

scholarly journals Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review

2020 ◽  
Author(s):  
Danielle R. L. Brogden ◽  
Una Walsh ◽  
Gianluca Pellino ◽  
Christos Kontovounisios ◽  
Paris Tekkis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Hpv Vaccination ◽  
Intraepithelial Neoplasia ◽  
Surgical Excision ◽  
Anal Intraepithelial Neoplasia ◽  
Response To Treatment ◽  
Treatment Modalities ◽  
Recurrence Rates ◽  
Anal Squamous Cell Carcinoma

Abstract Purpose Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN. Methods MEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included. Results Thirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison. Conclusions Although the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC.

scholarly journals Simple device to determine the pressure applied by pressure clips for the treatment of earlobe keloids

2015 ◽  
Vol 48 (03) ◽  
pp. 293-296 ◽  
Author(s):  
Aashish Sasidharan ◽  
Ann David ◽  
Amish Gohil ◽  
Ashish Kumar Gupta
Keyword(s):  
Steroid Injection ◽  
Surgical Excision ◽  
Compression Therapy ◽  
Treatment Modalities ◽  
Slight Variation ◽  
Simple Method ◽  
Pressure Therapy ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection ◽  
Common Problems

ABSTRACT Background: Keloids of the ear are common problems. Various treatment modalities are available for the treatment of ear keloids. Surgical excision with intralesional steroid injection along with compression therapy has the least recurrence rate. Various types of devices are available for pressure therapy. Pressure applied by these devices is uncontrolled and is associated with the risk of pressure necrosis. We describe here a simple and easy to use device to measure pressure applied by these clips for better outcome. Objectives: To devise a simple method to measure the pressure applied by various pressure clips used in ear keloid pressure therapy. Materials and Methods: By using a force sensitive resistor (FSR), the pressure applied gets converted into voltage using electrical wires, resistors, capacitors, converter, amplifier, diode, nine-volt (9V) cadmium battery and the voltage is measured using a multimeter. The measured voltage is then converted into pressure using pressure voltage graph that depicts the actual pressure applied by the pressure clip. Results: The pressure applied by different clips was variable. The spring clips were adjustable by slight variation in the design whereas the pressure applied by binder clips and magnet discs was not adjustable. Conclusion: The uncontrolled/suboptimal pressure applied by certain pressure clips can be monitored to provide optimal pressure therapy in ear keloid for better outcome.

scholarly journals Recurrence of keloids after application of epidermal growth factor

2019 ◽  
Vol 6 (9) ◽  
pp. 3341
Author(s):  
Aneesh Joseph ◽  
Ajayakumar Kochunarayanan ◽  
Fobin Varghese ◽  
Kalesh Sadasivan
Keyword(s):  
Family History ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Surgical Excision ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Recurrence Rates ◽  
History Of ◽  
Study Population ◽  
Epidermal Growth

Background: Exact aetiology for keloid formation is yet unknown. The prime goal of the therapy is to decrease the process of scarring. Many modalities of treatment are available for keloids. With current treatment modalities, recurrence rates approaches 75%. This study was conducted to find out whether application of Epidermal growth factor will reduce recurrence rates of keloids, after surgical excision.Methods: An observational study was conducted by collecting details of 40 patients who underwent surgical excision of keloids followed by epidermal growth factor application over the wounds. The patients have been followed up to 6th months post excision and recurrence rates of keloids as well as overall scar quality were analysed.Results: Out of 45 patients included in the study, 16 (35.6 %) were males and rest females. The median age of the study population was 18.0 (with an IQR 16.0; 26.0). Out of 45 patients, 12 patients had family history of keloids (73%). Out of 45 patients, 8 had keloid tendency which amounts to 82%. Out of 45 patient who underwent treatment, 22 patient developed recurrence which is 48.9% Out of 45 patients included in the study, 16 (35.6 %) were males and rest females. The median age of the study population was 18.0 (with an IQR 16.0; 26.0). Out of 45 patients, 12 patients had family history of keloids (73%). Out of 45 patients, 8 had keloid tendency which amounts to 82%. Out of 45 patient who underwent treatment, 22 patient developed recurrence which is 48.9%.Conclusions: There is a dearth of randomized controlled trials supporting the efficacy of epidermal Growth factor in preventing keloid recurrence. The subjective improvements seen in some cases are encouraging. This study will be a foundation for future studies and will highlight the breadth of knowledge yet to be explored by this therapy.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

Two decades of experience on ablation in children with Ebstein’s anomaly

2021 ◽  
pp. 1-7
Author(s):  
Tevfik Karagöz ◽  
İlker Ertuğrul ◽  
Ebru Aypar ◽  
Aydın Adıgüzel ◽  
Hayrettin Hakan Aykan ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Atrial Tachycardia ◽  
Ebstein’S Anomaly ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Success Rates ◽  
Recurrence Rates ◽  
Ebstein's Anomaly ◽  
Accessory Pathways ◽  
Rare Occasion ◽  
The Right

Abstract Introduction: Accessory pathways are commonly seen due to delamination of tricuspid valve leaflets. In addition to accessory pathways, an enlarged right atrium due to tricuspid regurgitation and incisional scars creates substrates for atrial re-entries and ectopic tachycardia. We sought to describe our experience with catheter ablation in children with Ebstein’s anomaly. Methods and results: During the study period, of 89 patients diagnosed with Ebstein’s anomaly, 26 (30.9%) of them who underwent 33 ablation procedures were included in the study. Accessory pathways were observed in the majority of procedures (n = 27), whereas atrial flutter was observed in five, atrioventricular nodal reentrant tachycardia in five, and atrial tachycardia in two procedures. Accessory pathways were commonly localised in the right posteroseptal (n = 10 patients), right posterolateral (n = 14 patients), septal (n = two patients), and left posteroseptal (n = one patient) areas. Multiple accessory pathways and coexistent arrhythmia were observed in six procedures. All ablation attempts related to the accessory pathways were successful, but recurrence was observed in five (19%) of the ablations. Ablation for atrial flutter was performed in five patients; two of them were ablated successfully. One of the atrial tachycardia cases was ablated successfully. Conclusions: Ablation in patients with Ebstein’s anomaly is challenging, and due to nature of the disease, it is not a rare occasion in this group of patients. Ablation of accessory pathways has high success, but also relatively high recurrence rates, whereas ablation of atrial arrhythmias has lower success rates, especially in operated patients.

scholarly journals Management of extra-abdominal fibromatosis in a musculoskeletal tumour centre in Hong Kong

2021 ◽  
pp. 221049172198908
Author(s):  
Lam Wei Sze Yvette ◽  
Fong Sin Tak ◽  
Mak Ka Lok
Keyword(s):  
Watchful Waiting ◽  
Surgical Excision ◽  
Treatment Modalities ◽  
Management Approach ◽  
Conservative Approach ◽  
Management Options ◽  
Musculoskeletal Tumour ◽  
Female Predominance ◽  
Tumour Location ◽  
Marginal Status

Introduction: Fibromatosis is a benign disease yet prone to recurrence. The best treatment option remains controversial. The purpose of this study was to analyse the management approach in our musculoskeletal tumour centre. Materials and Methods: Thirty-four patients with extra-abdominal fibromatosis referred to our centre between 2000 to 2018 were included. Patients’ demographics, tumour location and size, year of diagnosis, treatment modalities, surgical margins, recurrence, and subsequent management were analysed. Results: Patients mostly presented in the second and third decade, with female predominance. Twenty-seven patients underwent excision. Other management options included ‘watchful waiting’, pharmacological treatment and radiotherapy. Recurrence rate was 51.9%. There was no statistically significant relationship between marginal status and recurrence. Conclusion: We report our experiences on management of fibromatosis, with strategy shifted from early excision to a conservative approach over the years. Surgical excision is still indicated in some situations. Tumour recurrence is not rare but second excision is not always necessary.

scholarly journals Adjuvant Radiotherapy after Surgical Excision in Keloids

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 730
Author(s):  
Jeong Won Lee ◽  
Ki Ho Seol
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adjuvant Therapy ◽  
Local Control ◽  
Adjuvant Radiotherapy ◽  
Surgical Excision ◽  
Recurrence Rates ◽  
High Tendency ◽  
Advantages And Disadvantages

Keloids are a benign fibroproliferative disease with a high tendency of recurrence. Keloids cause functional impairment, disfigurement, pruritus, and low quality of life. Many therapeutic options have been used for keloids. However, the high recurrence rates have led to the use of adjuvant therapy after surgical keloid excision. There are different radiotherapy regimens available, and the advantages and disadvantages of each are still unclear. The aim of this review is to explain the appropriate radiotherapy regimen for keloids as well as discuss the recent reports on keloid management with radiotherapy. Adjuvant radiotherapy after surgical excision for keloids yields excellent local control with tolerable side effects. Hypofractionated radiotherapy with a BED of more than 28 Gy (α/β value of 10) after excision is recommended in the light of its biologic background.

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