Background: Management of recalcitrant keloids has been frustrating and difficult. Despite many suggested modalities, the recurrence rate remains high.  The value of adjuvant high-dose-rate (HDR) brachytherapy in treatment of resistant keloids is assessed in this study.
METHODS: Eleven patients with recalcitrant keloid scars were treated with adjuvant brachytherapy. Each patient had failed excision, silicone compressions, and steroid injections previously.  Brachytherapy was initiated one day following excision. One time dose of 1000 cGy was applied. The scars were evaluated at 6 months and 24 months for recurrence and cosmetic appearance using a quantitative scale.
RESULTS: After a follow-up of 2 years, one patient had recurrence. Cosmetic results were considered to be good or excellent in all remaining patients. All patients except one were satisfied with the outcome.
CONCLUSIONS: Adjuvant brachytherapy is an effective modality in irradication of recalcitrant keloids, particularly in cases in which lesions are refractory to other modalities.