title: Adjuvance in refractory keloids using electron beams with a spoiler: Recent results.
abstract: OBJECTIVE
  To present clinical results of adjuvant irradiation of excised refractory keloid wounds using a novel bolus-free technique developed within our group to irradiate the skin surface with a linear accelerator.
  
  
  BACKGROUND
  The use of a bolus to increase surface dose over a newly excised keloid presents several problems. Previous solutions are unsatisfactory. Our technique is promising but needs to be evaluated in practice.
  
  
  METHODS
  Twenty refractory skin keloids in 19 patients were excised and irradiated in Hospital Plató (Barcelona, Spain) using a 6 MeV electron beam with a 4-mm aluminium spoiler. 15 Gy in fractions of 3 Gy were delivered to the excision site plus a safety margin. All patients were examined during the follow-up (median: 40 months, interval: 12-68 months) and toxicities were recovered.
  
  
  RESULTS
  At the end of the follow-up period, 76% of the cases had not recurred, while the complete response rate amounted to 53%. Residual hypertrophic scars were classified as partial responses. After therapy, itching and pain were observed in 30% of the patients, as well as one telangiectasia and two hyperchromatic scars.
  
  
  CONCLUSIONS
  Our technique avoids using a bolus while combining the benefits of electron beam therapy in keloids (fewer secondary effects, and fewer and shorter treatments) with a dose deposition adequate for skin surface treatments. Our results are in line with the most successful therapies evaluated in the literature, as secondary effects are acceptable and recurrence rates are low.
authors.affiliation: Oncology Department, Hospital Plató, C/Plató 21, 08006 Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Vila Capel
authors.affiliation: Centro Nacional de Dosimetria, Avda. Campanar 21, 46009, Valencia, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Vilar Palop
authors.affiliation: Oncology Department, Hospital Plató, C/Plató 21, 08006 Barcelona, Spain.
authors.forename: Agustí
authors.initials: A
authors.lastname: Pedro Olivé
authors.affiliation: IMO, Plaza República Argentina 7, 28002 Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Sánchez-Reyes Fernández
keywords: Electron therapy; Keloids; Spoiler; Superficial treatment