title: Postoperative management of keloids: low-dose-rate and high-dose-rate brachytherapy.
abstract: OBJECTIVE
  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
  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 16 Gy; HDR median dose was 12 Gy. 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 44 years (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 (>8 cm) (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.
authors.affiliation: Division of Radiotherapy, Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Varese, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: De Cicco
authors.affiliation: Division of Radiation Oncology and Radiobiology, National Center for Oncological Hadrontherapy CNAO, Pavia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vischioni
authors.affiliation: Division of Radiotherapy, European Institute of Oncology, Milan, Italy. Electronic address: andrea.vavassori@ieo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vavassori
authors.affiliation: Division of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Gherardi
authors.affiliation: Division of Radiotherapy, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy.
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.affiliation: Division of Radiotherapy, European Institute of Oncology, Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lazzari
authors.affiliation: Division of Medical Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cattani
authors.affiliation: Division of Medical Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Comi
authors.affiliation: Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: De Lorenzi
authors.affiliation: Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Martella
authors.affiliation: Division of Radiation Oncology and Radiobiology, National Center for Oncological Hadrontherapy CNAO, Pavia, Italy; Division of Radiotherapy, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007627:Keloid / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brachytherapy; Hypertrophic scar; Keloids