Papers of The 2nd Japan Scar Workshop

5. High-dose rate interstitial brachytherapy (Ir-192) for the management of keloids

Sumiko Yoshitatsu1, Ken Yoshida2,

1:Department of Plastic Surgery, Osaka National Hospital, Osaka, Japan
2:Department of Radiology, Osaka National Hospital, Osaka, Japan

We treated keloid scars using high-dose rate interstitial brachytherapy (HDR-ISBT) after keloidectomy. HDR-ISBT was delivered using microSelectron-HDRTM (Ir-192) (Nucletron, the Netherlands). Five patients each received a total of 12 Gy (5 mm from the center of the catheter) in two fractions (6 Gy/fraction) within 24 hours of surgery. Two patients demonstrated minimal recurrence: one on the ear lobe and one in the anterior thoracic region. Skin tension over the wound was high, and postoperative conservative therapy could not be continued in either patient. We treated the patient who had recurrence on the ear lobe with salvage treatment consisting of re-excision of the keloid and wound closure followed by HDR-ISBT of 24 Gy (5 mm from the center of the catheter) in 4 fractions within 48 hours. There was no recurrence seven months after the second surgery. Although the optimal dose, especially in areas of high wound tension, should be determined, HDR-ISBT can be useful in management of recurrent keloids because of its optimal dose distribution and better radioprotection of normal tissue.
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