Abstract

Background Recurrent keloids of the earlobe provide a challenging reconstructive and aesthetic problem. Numerous modalities have been attempted to prevent recurrence, with the use of radiation surfacing as the most effective post-excision adjuvant treatment. High-Dose-Rate (HDR) brachytherapy is a form of radiation delivery characterized by implantation of radioactive seeds through a hollow catheter directly into a patient's tumor site, the dose is calculated and delivered, and the catheter removed.

Methods All cases of surgical excision followed by adjuvant HDR brachytherapy over a five-year period were reviewed retrospectively. Treatment protocol included keloid excision with in-situ HDR brachytherapy catheter placement, primary or advancement flap wound closure and immediate post-operative HDR brachytherapy. Dosing was divided into three fractions of 500 cgy/dose/day.

Results The average age of twenty-five patients meeting inclusion criteria was 27.8 years. There were 56% males and 44% females, primarily of European descent (72%). An average follow-up interval was 35 months. There was a 92% treatment success rate with success defined as no recurrence of the keloid a minimum of two years post-operatively. The two treatment failures were a result of post-operative infection, amenable to antibiotics.

Conclusions Our results suggest our technique of combined surgery and HDR brachytherapy to be efficacious, having few recurrences and with few complications at an average 35 month follow-up. We offer considerations as to why HDR brachytherapy should be the preferred adjuvant modality for the management of these recurrent tumors.