Results of Keloid Treatment with Excision Followed By Brachytherapy

PURPOSE: Keloids are benign tumors of excessive scar tissue that can be painful, itching and cosmetically disturbing. Due to therapy resistance and recurrence treatment is challenging for patient and physician. Excision followed by brachytherapy has been successfully used to treat keloids, and is currently considered most effective in keloid treatment. Using brachytherapy dose of ionizing radiation should be as low as achievable while remaining effective, due to disadvantage side effects of radiation. This optimal fractionation scheme has not yet been determined.¹More information on results of specific schemes is needed.

MATERIALS AND METHODS: We retrospectively analyzed keloids treated with excision followed by 2 fractions of 9 Gy brachytherapy on the day of surgery from 2010 till June 2014 in the Erasmus University Medical Center Rotterdam, The Netherlands. Socio-demographics, keloid characteristics, complications, recurrences and additional treatments were collected; when data were missing chart review was supplemented by phone interviews.

RESULTS: We treated 87 keloids in 43 patients, 45% male, 9% fair skinned, 65% dark skinned, of whom17% had one keloid, while 28% had over ten keloids. Keloids were caused by trauma (30%) and acne (29%). The ear (25%) was most affected, followed by the pre-sternal area (20%). Many caused pain (66%) and itch (79%). Complications after excision with brachytherapy were (partial) wound dehiscence (29%), infections (10%), chronic wounds (21%), grade 1 radiation dermatitis (25%) and severe pigmentation changes (26%). We found 19 recurrences (22%), of which 16 were partial (18%) and rarely caused pain and caused fewer itches. Additional treatment with silicone sheets or corticosteroids was used in 25%; only two keloids were operated again after treatment.

CONCLUSIONS: We showed that excision followed by brachytherapy is effective as keloid treatment resulting in only 4% full and 18% partial recurrences, with significant reduction in pain and itch complaints. However, radiation had disadvantageous effects on wound healing causing high risk on hampered wound healing. Compared with other fractionation schemes the effectiveness of our scheme is similar, but the high biological effective dose resulted in more complications than described by others that used schemes of 2x6Gy, 4x3Gy, or 3x6Gy.^2-4 In conclusion, although excision followed by 2 fractions of 9 Gy brachytherapy is effective for keloid treatment we advocate a milder scheme to reduce wound complications.