Papers of The 6th Japan Scar Workshop

9. Post--Keloidectomy Irradiation Using a High-Dose-Rate Brachytherapy System

Shigehiko Kuribayashi1, Tsuguhiro Miyashita1, Yukiko Ozawa1, Marie Iwano1, Rei Ogawa2, Satoshi Akaishi2, Teruyuki Dohi2, Hiko Hyakusoku2, Shinichiro Kumita1
1:Department of Radiation Oncology, Nippon Medical School, Tokyo, Japan
2:Department of Plastic and Reconstructive Surgery, Graduated School of Medicine, Nippon Medical School Hospital, Tokyo, Japan

A study was conducted to evaluate the early results of high-dose-rate superficial brachytherapy (SBT) after keloidectomy.
Between April 2008 and April 2009, 21 patients with 36 histologically confirmed keloids were treated with postoperative SBT. The tube applicator was placed on the skin to match the area of the surgical wound, and a spacer 5 mm thick was placed between the skin and the applicator. A dose evaluation point was established at 2 mm below the skin surface, and 20 Gy was delivered in 4 daily fractions to keloidectomy scars on the anterior chest wall, scapular region, lower jaw and suprapubic region. A dose of 15 Gy was delivered in 3 daily fractions to lesions in other areas.
The median follow-up period was 18 months (range, 9 to 29 months). Therapeutic outcome was judged in terms of recurrence, control, or acute side effects.
Three keloids (9.7%) in two patients showed local recurrence, with a median time to failure after SBT of 12 months. All recurrences affected the anterior chest wall. Dysraphia occurred in only one patient with an anterior chest wall lesion. Excluding the cases of recurrence, acceptable cosmetic results were achieved.
Our results indicate that SBT is effective and safe for preventing the recurrence of keloids.
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