Luigi De Cicco1, Barbara Vischioni2, Andrea Vavassori3, Federica Gherardi4, Barbara Alicja Jereczek-Fossa5, Roberta Lazzari4, Federica Cattani6, Stefania Comi6, Francesca De Lorenzi7, Stefano Martella7, Roberto Orecchia8. 1. Division of Radiotherapy, Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Varese, Italy. 2. Division of Radiation Oncology and Radiobiology, National Center for Oncological Hadrontherapy CNAO, Pavia, Italy. 3. Division of Radiotherapy, European Institute of Oncology, Milan, Italy. Electronic address: andrea.vavassori@ieo.it. 4. Division of Radiotherapy, European Institute of Oncology, Milan, Italy. 5. Division of Radiotherapy, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy. 6. Division of Medical Physics, European Institute of Oncology, Milan, Italy. 7. Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy. 8. Division of Radiation Oncology and Radiobiology, National Center for Oncological Hadrontherapy CNAO, Pavia, Italy; Division of Radiotherapy, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy.
Abstract
PURPOSE: We report the experience of the Radiation Oncology Department of the European Institute of Oncology in Milan, Italy, on the adjuvant low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy. Brachytherapy might be useful to improve keloids recurrence rate or reduce keloids treatment side effects instead of external beam radiotherapy. METHODS AND MATERIALS: Data on 70 consecutive patients treated after complete keloid surgical excision were retrospectively analyzed. First 38 patients and 46 keloids were treated with adjuvant LDR brachytherapy and the following 39 patients and 50 keloids underwent HDR treatment. Median delivered dose of LDR therapy was 16 Gy; HDR median dose was 12 Gy. Sixty-four keloids (66.7%) were symptomatic at diagnosis with pain, itching, or stress. RESULTS: Fourteen relapses over 46 treated keloids (30.4%) were observed in the LDR group and 19 of 50 keloids (38%) in the HDR group (p = 0.521). Recurrence rate was significantly higher in males (p = 0.009), in patients younger than 44 years (p < 0.0001), for arms, neck, and chest wall anatomic sites (p = 0.0001) and for symptomatic keloids (p = 0.017). Aesthetic outcome was better in case of larger keloids (>8 cm) (p = 0.064). Symptomatic relief was achieved in 92% of HDR patients and only 68% of LDR patients (p = 0.032). CONCLUSIONS: Postoperative brachytherapy is an effective treatment for keloids. In our study, LDR and HDR treatments resulted in similar recurrence rate. Better symptomatic relief was reported in case of HDR treatment compared with the LDR regimen.
PURPOSE: We report the experience of the Radiation Oncology Department of the European Institute of Oncology in Milan, Italy, on the adjuvant low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy. Brachytherapy might be useful to improve keloids recurrence rate or reduce keloids treatment side effects instead of external beam radiotherapy. METHODS AND MATERIALS: Data on 70 consecutive patients treated after complete keloid surgical excision were retrospectively analyzed. First 38 patients and 46 keloids were treated with adjuvant LDR brachytherapy and the following 39 patients and 50 keloids underwent HDR treatment. Median delivered dose of LDR therapy was 16 Gy; HDR median dose was 12 Gy. Sixty-four keloids (66.7%) were symptomatic at diagnosis with pain, itching, or stress. RESULTS: Fourteen relapses over 46 treated keloids (30.4%) were observed in the LDR group and 19 of 50 keloids (38%) in the HDR group (p = 0.521). Recurrence rate was significantly higher in males (p = 0.009), in patients younger than 44 years (p < 0.0001), for arms, neck, and chest wall anatomic sites (p = 0.0001) and for symptomatic keloids (p = 0.017). Aesthetic outcome was better in case of larger keloids (>8 cm) (p = 0.064). Symptomatic relief was achieved in 92% of HDR patients and only 68% of LDR patients (p = 0.032). CONCLUSIONS: Postoperative brachytherapy is an effective treatment for keloids. In our study, LDR and HDR treatments resulted in similar recurrence rate. Better symptomatic relief was reported in case of HDR treatment compared with the LDR regimen.