Postoperative management of keloids: Low-dose-rate and high-dose-rate brachytherapy

Purpose: We report the experience of the Radiation Oncology Department of the European Institute of Oncology in Milan, Italy, on the adjuvant low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy. Brachytherapy might be useful to improve keloids recurrence rate or reduce keloids treatment side effects instead of external beam radiotherapy. Methods and Materials: Data on 70 consecutive patients treated after complete keloid surgical excision were retrospectively analyzed. First 38 patients and 46 keloids were treated with adjuvant LDR brachytherapy and the following 39 patients and 50 keloids underwent HDR treatment. Median delivered dose of LDR therapy was 16Gy; HDR median dose was 12Gy. Sixty-four keloids (66.7%) were symptomatic at diagnosis with pain, itching, or stress. Results: Fourteen relapses over 46 treated keloids (30.4%) were observed in the LDR group and 19 of 50 keloids (38%) in the HDR group (p=0.521). Recurrence rate was significantly higher in males (p=0.009), in patients younger than 44years (p <0.0001), for arms, neck, and chest wall anatomic sites (p=0.0001) and for symptomatic keloids (p=0.017). Aesthetic outcome was better in case of larger keloids (>8cm) (p=0.064). Symptomatic relief was achieved in 92% of HDR patients and only 68% of LDR patients (p=0.032). Conclusions: Postoperative brachytherapy is an effective treatment for keloids. In our study, LDR and HDR treatments resulted in similar recurrence rate. Better symptomatic relief was reported in case of HDR treatment compared with the LDR regimen.