|
5. High-dose rate interstitial brachytherapy (Ir-192) for the
management of keloids
Sumiko Yoshitatsu1, Ken Yoshida2,
1:Department of Plastic Surgery, Osaka National Hospital, Osaka,
Japan
2:Department of Radiology, Osaka National Hospital,
Osaka, Japan
|
|
We treated keloid scars using high-dose rate interstitial brachytherapy
(HDR-ISBT) after keloidectomy. HDR-ISBT was delivered using
microSelectron-HDRTM (Ir-192) (Nucletron, the Netherlands). Five
patients each received a total of 12 Gy (5 mm from the center of the
catheter) in two fractions (6 Gy/fraction) within 24 hours of surgery.
Two patients demonstrated minimal recurrence: one on the ear lobe and
one in the anterior thoracic region. Skin tension over the wound was
high, and postoperative conservative therapy could not be continued in
either patient. We treated the patient who had recurrence on the ear
lobe with salvage treatment consisting of re-excision of the keloid and
wound closure followed by HDR-ISBT of 24 Gy (5 mm from the center of the
catheter) in 4 fractions within 48 hours. There was no recurrence seven
months after the second surgery. Although the optimal dose, especially
in areas of high wound tension, should be determined, HDR-ISBT can be
useful in management of recurrent keloids because of its optimal dose
distribution and better radioprotection of normal tissue. |
