Table 3.
Chronological summary of studies pertinent to HDR superficial brachytherapy.
| Author | Patient/ keloid number | Scar location | Skin type | Follow-up | Definition of recurrence | Brachytherapy regimen | Time interval between surgery and first fraction | Recurrence rate | Comments |
|---|---|---|---|---|---|---|---|---|---|
| Wagner et al., 200030 | 139/166 | Thorax 27.1% Face 25.3% Neck 22.3% Abdomen 10.9% Leg 6% Others 8.4% |
Unspecified | 12 years | Not defined | Median overall dose 14 Gy (7.5–28.5) with median individual
dose 3 Gy (1.5–4) 90Sr-90Y applicator |
Within 48 h of surgery | 20% | Recurrence lowest on face and neck (2%) highest thorax
(49%), P < 0.001 Burn keloids poorer success rate than surgery/mechanical trauma (P < 0.001) No malignancies reported at 12-year follow-up S/E: acute erythema 24%, hypopigmentation 11% |
| Fraunholz et al., 200531 | 66/83 | Trunk 41% Ear 23% Neck 19% Sternum 13% Extremities 4% |
Unspecified | 30 years median (range = 10–71) |
Any kind of keloidal regrowth | 5 Gy / 4 fractions at 2 mm depth 90Sr applicator |
On day of surgery (75%), following day (15%), within next 5 days (10%) |
36% (self-reported) 39% (objective examination) |
41 patients answered questionnaire and 24 participated in
the follow-up examination 61% extremely or mainly satisfied with therapeutic and 51% with cosmetic outcome Cutaneous changes (including telangiectasias, dyspigmentation, redness) were found in the majority of patients (slight in 17%, moderate in 33% and severe in 37%) |
| Narkwong et al., 200632 | 22/24 | Earlobe 100% | Unspecified | 14.8 months (range = 6–36) | Evidence of mass or obvious return of keloid | 15 Gy / 3 fractions | Start within 24 h post surgery | 12.5% (2 keloids at 6 and 15 months post treatment) | One patient had residual keloid post treatment grade 1
hypopigmentation (n = 1) and grade 3 fibrosis (n =
1) 7/22 lost to follow-up |
| Viani et al., 200933 | 612/892 | Thorax 41.4% Rest 58.6% *Histologically confirmed keloids* |
Unspecified | 61 months median (range = 6–130) |
Appearance of new keloid at site of treatment | 20 Gy / 10 fractions 90Sr-90Y beta ray applicator | Within 24 h of surgery for 36.4%; more than 24 h for rest | 12.4% | Recurrence associated with keloid size > 5 cm, burn scar
aetiology, previous treatment (P =
0.0001) S/E: telangiectasia 10.4% and resolved in all cases No malignancies reported |
| Kuribaya-shi et al., 201119 | 21/36 | Chest 44.5% Scapula 19.4% Lower jaw 16.7% Suprapubic 11.1% Others 8.3% *Histologically confirmed keloids* |
Asian (Japanese) patients | 18 months median (range = 9–29) | Elevation (even small) of treatment site | 20 Gy / 4 fractions for chest, scapula, lower jaw; 15 Gy / 3 fractions for other sites Ir 192 system |
Within 24 h of surgery | 9.7% (all on chest wall) | Transient erythema in almost all patients; no pigmentation changes |