To explore and compare the clinical efficacy and safety of different methods combined with radiation therapy (RT) for repairing thin scar tissue.

A retrospective analysis was conducted on 38 patients with chest scars (64 scars) admitted to the Department of Plastic Surgery in Inner Mongolia Medical University Affiliated Cancer Hospital from October 2019 to October 2022, as well as 16 patients with chest scars (35 scars) admitted to the Department of Burn and Plastic Surgery in 969th Hospital of in the Joint Logistics Support Force of the People′s Liberation Army. According to different treatment methods, they were divided into radiotherapy (RT) group (n=18), surgery combined with radiotherapy (SCR) group (n=19), and CO₂ dot array laser combined with radiotherapy (LCR). The combined with radiosurgery (LCR) group (n=17) had 34, 33, and 32 scars in the three groups of patients, respectively. Before treatment, 6 months and 12 months after treatment, the Vancouver scar scale (VSS) and patient and observer scar assessment scale (POSAS) were used to evaluate the degree of scar improvement and clinical efficacy. The Likert scale was used to evaluate satisfaction, and an online questionnaire was used to evaluate adverse reactions and recurrence rates. Treatment related indicators were recorded.

The total POSAS score and VSS score of patients in the RT group, SCR group, and LCR group were lower than before treatment at 6 and 12 months after treatment (P<0.01). The total POSAS score and VSS score of the RT group increased compared to 6 months after treatment, while the total POSAS score and VSS score of the SCR and LCR groups decreased compared to 6 months after treatment. At 12 months after treatment, the LCR group had the lowest total POSAS score and VSS score, followed by the SCR group, and the RT group had the highest score. There was a significant difference in the effective rate between the SCR group and the LCR group compared to the RT group( χ²=19.304, P<0.01), there was no significant difference between the SCR group and the LCR group. The effective rate of the RT group was 27.78%, the SCR group was 78.95%, and the LCR group was 94.12%. There was a significant difference in satisfaction between the SCR group and the LCR group compared to the RT group( χ²=10.41, P<0.01), there was no significant difference between the SCR group and the LCR group. The satisfaction rate of the RT group was 52.94%, the SCR group was 84.21%, and the LCR group was 94.12%. After 12 months of treatment, the recurrence rate in the RT group was 72.22%, the SCR group had a recurrence rate of 21.05%, and the LCR group had a recurrence rate of 5.88%. There was a significant difference in the one-year recurrence rate( χ²=19.30, P<0.01).

LCR has the characteristics of simple and efficient operation, easy nursing, minimal trauma, good therapeutic effect, and high safety. It is easy for patients to accept, especially suitable for patients with multiple or large areas of thin scars, obvious surgical contraindications, or unwillingness to receive surgical treatment. Simple RT is mainly used to improve subjective symptoms such as pain and itching, while SCR is more suitable for the treatment of isolated or small amounts of medium and large scars. In clinical practice, it should be flexibly selected according to the actual situation.