Eight Year Results in the Treatment of Keloids by HDR Brachytherapy

English

Heather Jones, MD
University of Pennsylvania Cancer Center
Ultima Vez Modificado: 5 de noviembre del 2001

Presenter: B. Guix
Presenter's Affiliation: Radiation Oncology, Fundacio IMOR, Barcelona, Spain
Type of Session: Scientific

Background
Keloids form as a result of abnormal growth of scar tissue usually after injury to the skin. The incidence ranges form 3 to 15%. The formation of keloids can result in itching, burning and bleeding. This prospective study analyzes the treatment of keloids by HDR brachytherapy with or without previous surgery.

Materials and Methods

One hundred and sixty nine patients with keloid scar were treated with HDR brachytherapy

One hundred and thirty four patients were females and 35 males.

Seventy-seven keloids were on the face, 73 on the trunk and 19 on the extremities. The average length of the keloid was 4.2 cm and the average width was 1.8 cm.

One hundred and forty seven patients had surgical excision of the keloid tissue prior to brachytherapy and 22 were treated exclusively by HDR brachytherapy.

Brachytherapy was initiated in the first 24 hours after surgery.

4 fractions of 500 cGy at 1 cm from the center of the catheter with geometrical dose distribution optimization were given, in 24 hour (at 09.00, 15.00, 21.00 and 09.00).

In those patients not treated by surgery, the plastic tube was placed under the skin with local anesthesia and 6 fractions of 300 cGy in 2 two days were given.

Results

8 patients (4.7 %) experienced a recurrence of their keloid

5/147 (3.4%) patients treated with surgery and HDR had a recurrence

3/22 (13.6 %) treated exclusively by HDR brachytherapy experienced a recurrence.

Cosmetic results were considered to be good or excellent in 130/147 patients treated with prior excision and in 17/22 patients without surgery. Ten patients developed skin pigmentation changes and 12 patients telangiectasias.

Author's Conclusions
HDR brachytherapy was a highly effective treatment of keloids. It was well tolerated and no significant side effects were noted. It was preferably to have the keloid completely excised prior to HDR brachytherapy. Brachytherapy was preferable to superficial x-rays or low energy electrons because the more selective deposition of radiation in the tissue, and the less amount of normal tissue irradiated. HDR was preferable to LDR brachytherapy because it can be done in an out-patient basis, its relatively low cost, excellent radiation protection and better dose distribution obtained. This allowed a high local control with no significant HDR brachytherapy related sequelae or complication.

Clinical/Scientific Implications
This study indicates that treatment of keloids with HDR results gives good cosmesis and reduces dose to normal tissue, which is paramount in the treatment of non-malignant disease with radiation. The long-term data would also seem to indicate no excessive late effects with the increase in dose.