硅胶片对90Sr-90Y敷贴治疗瘢痕疙瘩中放射性皮炎预防作用的研究

目的 研究90Sr-90Y敷贴治疗瘢痕疙瘩中硅胶片对放射性皮炎的预防作用。 方法 回顾性分析2019年1月至2021年6月于上海交通大学附属第六人民医接受90Sr-90Y敷贴治疗的175例瘢痕疙瘩患者的临床资料，其中男性 81例、女性94例，年龄（27.2±3.7）岁。采用信封随机分组法将患者分为对照组（57例）、1 mm厚硅胶片保护组（55例）、2 mm厚硅胶片保护组（63例）。所有患者均使用90Sr-90Y敷贴器进行多次小剂量治疗，1 mm厚硅胶片保护组患者和2 mm厚硅胶片保护组患者分别使用1 mm、2 mm厚硅胶片对病灶周围皮肤进行保护。采用美国肿瘤放疗学会的放射性皮炎分级标准对3组患者的放射性皮炎进行分级，比较各组患者放射性皮炎的发生率及严重等级。分析90Sr-90Y敷贴治疗疗程及硅胶片保护对发生严重放射性皮炎的影响。符合正态分布的计量资料的2组间比较采用独立样本t检验（方差齐），3组间的比较采用单因素方差分析；计数资料的组间比较采用卡方检验；采用单因素Logistics回归分析对影响疗效的因素进行分析。 结果 1 mm厚硅胶片保护组和对照组患者放射性皮炎发生率（83.6%对89.5%）间的差异无统计学意义（χ2=0.815，P>0.05）；与对照组和1 mm厚硅胶片保护组相比，2 mm厚硅胶片保护组的放射性皮炎的发生率显著降低（89.5% 对83.6% 对 54.0%），且差异均有统计学意义（χ2=18.108、11.738，均P<0.05）。1 mm厚硅胶片保护组患者总体放射性皮炎的严重等级低于对照组（1.05±0.65 对 1.37±0.75），且差异有统计学意义（t=−2.409，P<0.05），2 mm厚硅胶片保护组患者放射性皮炎的严重等级（0.63±0.66）低于对照组和1 mm厚硅胶片保护组，且差异均有统计学意义（t=−5.749、−3.473，均P<0.05）。90Sr-90Y敷贴治疗疗程的增加会使瘢痕疙瘩患者严重放射性皮炎发生的风险增加（OR=2.348，95%CI ：1.524~3.618，P<0.001），不同厚度硅胶片的使用可降低严重放射性皮炎的发生风险（1 mm厚硅胶片：OR=0.273，95%CI：0.109~0.685，P<0.01；2 mm厚硅胶片：OR=0.099，95%CI：0.034~0.293，P<0.001）。 结论 90Sr-90Y敷贴治疗瘢痕疙瘩患者时，使用2 mm厚硅胶片保护周围正常皮肤组织，能够显著降低放射性皮炎的发生率和严重程度。

Study on the prophylactic effect of silicone on radiodermatitis in keloid treated with 90Sr-90Y applicator

Objective To investigate the prophylactic effect of silicone on radiodermatitis during the treatment of keloid by using 90Sr-90Y applicator. Methods The clinical data of 175 patients who received 90Sr-90Y applicator for keloids at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to June 2021 were retrospectively analyzed. The patients included 81 males and 94 females, with ages of (27.2±3.7) years. The patients were divided into the control group (57 cases), the 1 mm-thick silicone protection group (55 cases), and the 2 mm-thick silicone protection group (63 cases) by using the envelope random grouping method. All the patients were treated with multiple small-dose radiation therapy by using a 90Sr-90Y applicator. The skin around the lesion was respectively protected with 1 mm- and 2 mm-thick silicone in the 1 mm-thick and 2 mm-thick silicone protection groups. Radidermatitis for the three groups of patients was graded using the radidermatitis grading criteria of the Radiation Therapy Oncology Group. The incidence and severity of radiodermatitis were compared among the groups. The effects of the treatment course and silicone protection on the occurrence of severe radidermatitis were analyzed. Independent sample t-test (equal variances assumed) was used to compare the two groups for the measurement data in accordance with normal distribution. One-way ANOVA was adopted to compare the three groups. The chi-squared test was conducted to compare the count data in the three groups. Lastly, the factors that affected the efficacy of the treatment were analyzed via univariate Logistic regression analysis. Results No statistically significant difference was found in the incidence of radiodermatitis between the 1 mm-thick silicone protection group and the control group (83.6% vs. 89.5%, χ2=0.815, P=0.367). The incidence of radiodermatitis was significantly lower in the 2 mm-thick silicone protection group than in the control group and the 1 mm-thick silicone protection group (89.5% vs. 83.6% vs. 54.0%), and the differences were statistically significant (χ2=18.108, 11.738; both P<0.05). The severity of overall radiodermatitis was lower in the 1-mm thick silicone protection group than in the control group (1.05±0.65 vs. 1.37±0.75), and the difference was statistically significant (t=−2.409, P<0.05). The severity of radiodermatitis in the 2 mm-thick silicone protection group (0.63±0.66) was lower than that in the control group and the 1 mm-thick silicone protection group, and the differences were statistically significant (t=−5.749, −3.473; both P<0.05). The increase in the number of treatment courses augmented the risk of radiodermatitis (OR=2.348, 95%CI: 1.524–3.618, P<0.001). Meanwhile, the use of silicone with different thicknesses can reduce the risk of radiodermatitis (1 mm-thickness silicone: OR=0.273, 95%CI: 0.109–0.685, P<0.01; 2 mm-thickness silicone: OR=0.099, 95%CI: 0.034–0.293, P<0.001). Conclusion During the treatment of keloid with 90Sr-90Y applicator, the use of 2 mm-thick silicone to protect the surrounding normal skin tissue can significantly reduce the incidence and severity of radiodermatitis.