To investigate the clinical effects of X-ray radiation on superficial layer of skin with SRT-100 equipment in the treatment of hypertrophic scars in children.

Data of 27 children with 42 hypertrophic scars treated in Kunming Children′s Hospital from September 2020 to May 2023 were analyzed retrospectively and divided into the routine treatment group (n=21) and combination with radiotherapy group (n=21). The children in the routine treatment group only received conventional anti-scar treatment (external use of ant-scar drugs and pressure therapy). The children in the combination with radiotherapy group received X-ray radiation on superficial layer of skin with SRT-100 equipment on the basis of conventional anti-scar treatment. Hypertrophic scars started to be irradiated 1-3 months after wound healing, once a week for 4 times and later continuation or not depending on visual scar hyperplasia conditions after an interval of 1-2 months, and 4-8 times as a course of treatment. The parameters were set as 50-70 kV, single dose of 350-400 cGy, the total dose of no more than 30 Gy and irradiation time of 30-60 seconds once. Protecting normal skin around scars with lead sheets during irradiation and the glandular sites were prohibited from irradiation. Before treatment (scar progression within 2 months) and after treatment (scar progression for 6 months: the routine treatment group received routine treatment for 4-5 months, while the combined with radiotherapy group received four doses of radiation and then three or four months later, or one to two months after eight doses of radiation), the Vancouver scare scale (VSS) was used to score, and the effectiveness of treatment and the satisfaction of children′s family were recorded. All children were followed up for 6-24 months, during which the adverse reactions were observed. The data were comparied by t-test, chi-square test and wilcoxon test between the two groups.

The VSS scores were (11.9±1.2) points and (9.7±1.7) points before and after the routine treatment, and the difference was statistically significant (t=10.869, P<0.001); none was judged as markedly effective, 18 cases were judged as effective, and 3 cases did not show any effect, thus the effective rate and the significant effective rate were 85.7% and 0; none of children′s families got very satisfied, 2 children′s families got relatively satisfied, 16 children′s families got generally satisfied, and 3 children′s families got dissatisfied, and the overall satisfaction was 85.7% in the routine treatment group, and in which the side effects such as pigmentation and dry skin were found without any scar rupture and dermatitis. The VSS scores were (11.2±1.2) points and (4.7±0.8) points before and after the treatment in the combination with radiotherapy group and the difference was statistically significant (t=24.726, P<0.001). The reduction of VSS scores was significantly greater in the combination with radiotherapy group than in the routine treatment group (t=12.805, P<0.001). Fourteen cases were judged as markedly effective, 7 cases were judged as effective, and no ineffective case was found, with the effective rate of 100% and the significant effect rate of 66.7%; 14 children′s families got very satisfied, 7 children′s families got relatively satisfied, and no generally satisfied or dissatisfied cases were found, with the overall satisfaction of 100% in the combination with radiotherapy group. There were 4 children who were found radiation dermatitis, epidermal ulceration and eczema, healed after routine dressing change, and the other side effects were transient pigmentation and dry skin in the combination with radiotherapy group. The effective rate (Z=-4.568, P<0.001) and the overall satisfaction (Z=-5.668, P<0.001) were higher in the combination with radiotherapy group than in the routine treatment group.

X-ray radiation on the superficial layer of skin with SRT-100 equipment can effectively inhibit scar hyperplasia with a high satisfaction of children′s families and a low incidence of adverse reaction, thus it is an alternative therapy for the prevention and treatment of hypertrophic scars in children with advantages of convenience, no pain, safety and obvious curative effect.