Postoperative Management of Keloids with High-Dose-Rate Brachytherapy
PO-1810
Abstract
Postoperative Management of Keloids with High-Dose-Rate Brachytherapy
Authors: Stefano Durante1, Andrea Vavassori1, Jessica Franzetti1,2, Marco Rotondi1,2, Stefania Comi3, Rafaella Cambria3, Federica Cattani3, Francesca De Lorenzi4, Mario Rietjens4, Roberta Lazzari1, Roberto Orecchia5, Barbara Alicja Jereczek Fossa1,2
1European Institute of Oncology, Division of Radiation Oncology, Milan, Italy; 2University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy; 3European Institute of Oncology, Unit of Medical Physics, Milan, Italy; 4European Institute of Oncology, Plastic and Reconstructive Surgery, Milan, Italy; 5European Institute of Oncology, Scientific Directorate, Milan, Italy
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Purpose or Objective
The effectiveness of postoperative interventional radiotherapy (POIRT)
in preventing keloid recurrences after surgical excision has already been
confirmed. We report our updated monocentric experience on the adjuvant
high-dose-rate (HDR) interstitial brachytherapy.
Material and Methods
We retrospectively analyzed the medical records of 133 consecutive
patients (104 female; 29 male) with 172 keloids. Patients receiving complete
surgical excision and HDR-POIRT treatment from October 2004 to February 2021.
Median age at the time of treatment was 43 years (range 16 - 76). During the
surgical procedure, at the end of the scar excision, the dedicated plastic tube
for brachytherapy was inserted through the center of the wound. Surgical wound
was considered as the target volume, and the irradiation usually started within
4-6 hours after surgery. The scheduled dose was 12 Gy in 4 fractions, two
fraction per day with at least 6 hours in-between. Recurrence was defined as
the presence of a new keloid in a previously treated site (both along the scar
or only at its extremity).
Results
Twenty-one patients were lost at follow-up,
therefore the data of 112 patients and 147 keloids are presented. No
complications, such as bleeding or scar infections, occurred either during
treatments or after catheter removal. The most frequent early toxicity was
erythema (18%), but most of the patients had no toxicity (80%). Late toxicity
was registered in 22% of the 33 treated keloids. Over a median follow-up time
of 40 months, 44 treated keloids (26%) relapsed. The median time of relapse was
8 months. Three patients received a re-treatment (surgery and brachytherapy)
after the relapse of the keloid; after re-treatment no furthers relapses were
registered.
Conclusion
Brachytherapy for keloids adjuvant treatment after surgical excision
is an effective and safe treatment. Use of relatively low brachytherapy dose
may partially explain the relapse rate observed in our series. Further
prospective investigation with different treatment schedules will be planned in
order to establish the optimal dose that should be employed in the
postoperative treatment of this benign condition.