Postoperative radiotherapy with high dose rate Iridium 192 mould for prevention of earlobe keloids

Radiation Oncology Division, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 05/2006; 89(4):428-33.
Source: PubMed


A 50% to 80% recurrence rate of earlobe keloids can occur following a simple excision. Many modalities, including radiotherapy, have been suggested to reduce the postoperation recurrence.
The aim of the present study was to determine the efficacy of postoperative radiotherapy by a high dose rate Iridium 192 mould in the prevention of earlobe keloids recurrence.
Between March 1999 and March 2003, 22 patients with 24 earlobe keloids were treated by radiotherapy immediately following surgical excision. A dose of 15 Gray in 3 fractions was delivered at a point placed 5 mm from the axis of the Iridium sources.
From the 22 patients with 24 keloids who were treated, 15 patients with 16 keloids were followed for a minimum of 6 months. Recurrence occurred in two keloids (12.5%). There were no severe adverse effects.
Postoperative radiotherapy by high dose rate Iridium 192 mould was an effective prevention of earlobe keloids recurrence. It was well tolerated and did not present any significant side effects.

  • Source
    • "Narkwong et Thirakhupt [19] 16 HDR 3 × 5 Gy 2 12,5 Ogawa et al. [33] "
    [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: Evaluation of perioperative treatment of keloid scars with electron beam therapy or iridium 192 low dose rate brachytherapy. PATIENTS AND METHODS: From 1994 to 2010, 95 patients with 142 keloid scars have been treated by immediate perioperative irradiation and retrospectively reviewed in our institute: 116 scars were treated by electrontherapy and 26 by brachytherapy. RESULTS: In the electrontherapy group treated locations were: earlobe (n=88, 76%), thorax (n=14, 12%), neck (n=9, 8%), limbs (n=5, 4%). The median size of lesions was 3cm (range [R]: 0.5-18cm). In 95.6% of cases, a dose of 15Gy was delivered in five fractions of 3Gy. The median follow-up was 70 months (R: 7-161 months). The 2-year and 5-year local control were respectively 69% (95% confidence interval [95% CI]: 59-76%) and 55% (95% CI: 45-64%). In the brachytherapy group treated locations were: neck (n=3, 11%), earlobe (n=8, 32%), abdomen (n=3, 11%), thorax (n=2, 8%), limbs (n=10, 38%). The median size of lesions was 6.6cm (R: 1.7-28cm). The median dose delivered at 5mm from the source was 20Gy (R: 15-20.69). The median follow-up was 113 months (R: 21-219 months). The 2-year and 5-year local control were respectively 84.6% (95% CI: 64-94%) and 73.5% (95% CI: 49-87%). So far, no radiation-induced cancer has occurred. A trend to a better local control with brachytherapy was noted (compared to electrontherapy, 2-year relapse is halved with brachytherapy) though this difference did not reach the significance (P=0.0991), probably due to the reduced number of patients in the brachytherapy group. CONCLUSION: Brachytherapy seems to provide better local control compared to electrontherapy, and should be proposed as first line treatment. However, electrontherapy is an interesting alternative in case of difficulty to realize brachytherapy. There is probably a dose effect: according to published data, 25 to 30Gy should at least be proposed.
    Full-text · Article · Jan 2013 · Cancer/Radiothérapie
  • Article: Keloids
    [Show abstract] [Hide abstract]
    ABSTRACT: Our experts stress the importance of educating patients who develop keloids on the value of informing other treating physicians of their keloidal tendency, avoiding any unnecessary surgeries, seeing a dermatologist after any surgery where the integrity of the skin was compromised, using insect repellants in the summer, refraining from picking, rubbing, scratching (patients can be given a prescription for flurandrenolide tape) and most importantly the benefit/risk of compliance and continued follow-up. Patients with nodulocystic acne who are prone to develop keloids should be treated with isotretinoin. The preferred method for treatment of earlobe keloids is 3-40 mg intralesional triamcinolone with or without adjunctive topical steroids followed by cold steel, pulsed-dye or CO2 laser removal. Iced xylocaine followed by liquid nitrogen may be used to ease the pain of injections. Postoperatively, pressure earrings or silicone compression pads are applied to the surgical site, which are subsequently injected with 40 mg of triamcinolone every 2-4 weeks for 6 months depending on the response. 5-FU may be used adjunctively. Extremely large or recalcitrant tumors may require irradiation. Moderately firm presternal keloids can be softened by the application of flurandrenolide tape occlusion for several weeks. Treatment of thicker tumors is achieved by injecting 40 mg triamcinolone intralesionally after pretreating with occluded lidocaine and or liquid nitrogen (steroid injected during the thaw phase). Shaving and/or pulsed dye laser can be used to remove residual tumor. Pressure dressings, monthly intralesional injections (40 mg triamcinolone), and 5-FU are suggested. Radiation therapy can be considered in the immediate to late postoperative period. Test spots should be performed on any patient with a history of keloids before undergoing resurfacing procedures. Laser hair removal as well as excisions on the mandibular or thoracic skin may be particularly risky in this patient population. Removal of dermatosis papulosa nigrans or acrochordons should not be undertaken in patients who form keloids on the chest or extremities.
    No preview · Article · May 2007 · Dermatologic Therapy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Keloid is a hypertrophic scar that may arise within 6 months after injury in susceptible individuals. Different therapies like surgical excision, intralesional steroid injections, local application of pressure, or postoperative irradiation with x-rays or electrons are reported. Although an immediate starting of therapy after surgery is usually recommended, delayed radiotherapy may also be effective. We report on a 48 year old women with a history of an invasive ductal carcinoma in the upper lateral quadrant of the left breast. A breast conserving tumor resection with axillary dissection was performed. An adapting reduction mammaplasty was carried out on the right breast for cosmetic reasons at the same time. 5 weeks after surgery, adjuvant radiotherapy was applied with a total dose of 59 Gy to the left breast. 10 weeks after surgery and by the end of radiotherapy, a keloid had developed on the right breast with reduction mammaplasty, but not on the left irradiated one. 8 months after initial surgery the patient's keloid formation on the right mamma was removed by surgical resection and a keloid prevention with postoperative radiotherapy with 20 Gy was performed. Postoperative radiation of the scar prevented effectively keloid formation while simultaneously a hypertrophic scar developed in the non-irradiated scar.
    Preview · Article · Aug 2007 · European journal of medical research
Show more