Purpose

Keloids arise from dysregulated wound healing, characterized by excessive fibroblast activity and collagen deposition. Despite multiple treatment modalities, recurrence rates after excision remain high. High-dose-rate (HDR) brachytherapy delivers localized radiation, minimizing exposure to surrounding structures. This study evaluated clinical outcomes and dosimetric parameters in patients undergoing surgical excision followed by peri-operative HDR brachytherapy for keloid management at a single institution.

Material and methods

In this retrospective analysis, 32 patients treated over the past 6 years who underwent scar excision and immediate peri-operative brachytherapy to a dose of 15 Gy in 3 fractions, were analyzed. Outcomes, including recurrence, acute reactions, delayed wound healing, and late pigmentary or cosmetic changes, were assessed via telephonic interviews, while no direct clinical examination was performed. Dosimetric parameters (treatment length, volume, V100%, V150%, and V200%) were recorded for 24 patients with retrievable simulation scans. Statistical associations between patient-treatment variables and recurrence were assessed.

Results

The study comprised 17 males and 15 females (median age, 33 years; range, 21-65 years). Keloid sites included the ear (50%), chest (40.6%), extremities (6.3%), and scapula (3.1%). Median length treated and volume were 3.75 cm and 1.7 cm3, respectively; mean V100% was 91.15% (±4.87), and V200% was 26.71% (±7.99). At a median follow-up of 25 months, four patients (12.5%) experienced recurrence. No significant associations were found between recurrence and sex, lesion site, etiologic cause, prior treatment, age, treatment length or volume, or dosimetric parameters (all p > 0.05). Acute and late toxicities were minimal, with only one case of transient paraesthesia, and no reported secondary malignancies.

Conclusions

Surgical excision and immediate peri-operative brachytherapy can be considered in the first occurrence of keloid. Attention should be paid to interval between surgery and radiotherapy (RT) start, and to the dosimetric optimization of RT treatment.