title: Perioperative Interstitial High-Dose-Rate Brachytherapy for the Treatment of Recurrent Keloids: Feasibility and Early Results.
abstract: OBJECTIVE
  To prospectively evaluate high-dose-rate brachytherapy in the treatment of therapy-resistant keloids and report first results, with emphasis on feasibility and early treatment outcome.
  
  
  METHODS
  From 2009 to 2014, 24 patients with 32 recurrent keloids were treated with immediate perioperative high-dose-rate brachytherapy; 3 patients had been previously treated with adjuvant external beam radiation therapy and presented with recurrences in the pretreated areas. Two or more different treatment modalities had been tried in all patients and had failed to achieve remission. After (re-)excision of the keloids, a single brachytherapy tube was placed subcutaneously before closing the wound. The target volume covered the scar in total length. Brachytherapy was given in 3 fractions with a single dose of 6 Gy in 5 mm tissue depth. The first fraction was given within 6 hours after surgery, the other 2 fractions on the first postoperative day. Thus, a total dose of 18 Gy in 3 fractions was administered within 36 hours after the resection.
  
  
  RESULTS
  The treatment was feasible in all patients. No procedure-related complications (eg, secondary infections) occurred. Nineteen patients had keloid-related symptoms before treatment like pain and pruritus; disappearance of symptoms was noticed in all patients after treatment. After a median follow-up of 29.4 months (range, 7.9-72.4 months), 2 keloid recurrences and 2 mildly hypertrophied scars were observed. The local control rate was 94%. Pigmentary abnormalities were detected in 3 patients, and an additional 6 patients had a mild delay in the wound-healing process.
  
  
  CONCLUSIONS
  The early results of this study prove the feasibility and the efficacy of brachytherapy for the prevention of keloids. The results also suggest that brachytherapy may be advantageous in the management of high-risk keloids or as salvage treatment for failure after external beam therapy.
authors: Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany. Electronic address: ping.jiang@uksh.de.
authors: Ping
authors: P
authors: Jiang
authors: Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors: René
authors: R
authors: Baumann
authors: Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Radiation Oncology, University of Copenhagen, Copenhagen, Denmark.
authors: Juergen
authors: J
authors: Dunst
authors: Department of Reconstructive Surgery, Lubinus Clinic Kiel, Kiel, Germany.
authors: Matthias
authors: M
authors: Geenen
authors: Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors: Frank-André
authors: FA
authors: Siebert
authors: Department of Radiation Oncology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Radiation Oncology, Community Clinic Köln, Köln, Germany; Department of Radiation Oncology, University Witten/Herdecke, Witten, Germany.
authors: Peter
authors: P
authors: Niehoff
authors: Department of Reconstructive Surgery, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors: Julia
authors: J
authors: Bertolini
authors: Department of Reconstructive Surgery, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors: Daniel
authors: D
authors: Druecke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D007627:Keloid / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D016896:Treatment Outcome; D014945:Wound Healing / Q000528:radiation effects; D055815:Young Adult
chemical_list: D007496:Iridium Radioisotopes