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Papers of The 1st Japan Scar Workshop |
2. High-Dose Rate Interstitial Brachytherapy
( Ir-192 ) In The
Management of Keloids
Yoshitatsu S, Yoshida K, Kobayashi M
Department of Plastic Surgery, Osaka National Hospital, National
Hospital Organization, Osaka, Japan
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We treated 7 patients with keloid scars using high-dose-rate
interstitial brachytherapy (HDR-ISBT) after surgery.All patients
complained of symptoms or disfigurement related to the keloids, which
had been recalcitrant to other conservative therapies. The keloid scars
were excised completely or as much as possible. Plastic hollow catheters
(applicators) were secured within 5 mm of the dermis, where the keloids
originated. Then the wound was closed using subcutaneous and dermal
sutures. Computer optimization was used not only to deliver effective
doses of radiation to the wound but also to minimize doses to the
surrounding normal tissue. HDR-ISBT was delivered using
microselectron-HDRTM (Ir-192) (Nucletron, the Netherlands). All patients
received a total of 12 Gy in 2 fractions (6 Gy/fraction) within 24 hours
of the surgery. All patients were relieved of their keloid-related
symptoms. Two had minimal recurrence but also experienced improved
cosmesis. Although our experience remains limited, interstitial HDR-ISBT
can be effective in the treatment of recalcitrant keloids, and it has
advantages over electron-beam RT, including better dose distribution,
better radioprotection of normal tissue, and briefer treatment. |
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