Papers of The 1st Japan Scar Workshop

2. High-Dose Rate Interstitial Brachytherapy
 ( Ir-192 ) In The Management of Keloids

Yoshitatsu S, Yoshida K, Kobayashi M
Department of Plastic Surgery, Osaka National Hospital, National Hospital Organization, Osaka, Japan

We treated 7 patients with keloid scars using high-dose-rate interstitial brachytherapy (HDR-ISBT) after surgery.All patients complained of symptoms or disfigurement related to the keloids, which had been recalcitrant to other conservative therapies. The keloid scars were excised completely or as much as possible. Plastic hollow catheters (applicators) were secured within 5 mm of the dermis, where the keloids originated. Then the wound was closed using subcutaneous and dermal sutures. Computer optimization was used not only to deliver effective doses of radiation to the wound but also to minimize doses to the surrounding normal tissue. HDR-ISBT was delivered using microselectron-HDRTM (Ir-192) (Nucletron, the Netherlands). All patients received a total of 12 Gy in 2 fractions (6 Gy/fraction) within 24 hours of the surgery. All patients were relieved of their keloid-related symptoms. Two had minimal recurrence but also experienced improved cosmesis. Although our experience remains limited, interstitial HDR-ISBT can be effective in the treatment of recalcitrant keloids, and it has advantages over electron-beam RT, including better dose distribution, better radioprotection of normal tissue, and briefer treatment.
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