Adjuvant high dose rate brachytherapy (Ir-192) in the management of keloids which have recurred after surgical excision and external radiation

A Primary Protocol for the Management of Ear Keloids: Results of Excision Combined with Intraoperative and Postoperative Steroid Injections

“…20 The recent development of brachytherapy has helped to alleviate some of these drawbacks. 21 However, the risks of radiation and the significant increase in cost associated with its use lead many physicians to seek other options in treatment.…”

A Radiobiological Analysis of Multicenter Data for Postoperative Keloid Radiotherapy

“…This study did not have the data to investigate whether orthovoltage irradiation is adequate for keloid irradiation, but the physical profile of the beam (depth-dose curve) suggests that it should be adequate. Interstitial brachytherapy appears to be an excellent technique for delivering high-dose postoperative radiotherapy in a short time after keloid excision (24)(25)(26)(27). Because the distribution of radiation from brachytherapy is less homogeneous than external beam irradiation and because the biological equivalence of a brachytherapy dose is a more complex calculation that stretches the limits of the linear-quadratic model, brachytherapy was not included in this analysis.…”

“…This study started with the approach of Kal and Veen (4) of pooling data (with updated literature) but differs by omitting series with interstitial brachytherapy (24)(25)(26)(27) and by investigating the radiobiological parameters (the a/b ratio) rather than assuming values. The starting hypotheses for this study were as follows:…”

Postoperative Strontium-90 Brachytherapy in the Prevention of Keloids: Results and Prognostic Factors

“…The largest experience with Ir-192 brachytherapy (855 keloids) was reported by Escarmant et al (14), who found a recurrence rate of 21% after surgery and Ir-192 brachytherapy. Garg et al (38) evaluated their experience with adjuvant HDR brachytherapy in patients who failed surgery and postoperative external radiation therapy. The salvage treatment consisted of excision of the keloid and wound closure followed by HDR brachytherapy with 15 Gy in three fractions, given on 3 consecutive days, beginning on the day of surgery.…”