Association of surgical excision and brachytherapy for the management of keloids

Many techniques have been described to prevent the appearance and relapse of keloids but most of them have an efficacy lower than 50%. Our objective is to describe our standardized management of keloids by associated surgery and brachytherapy. Surgery-brachytherapy is usually given only when less invasive treatments failed. Both a surgeon and a radiotherapist are involved. Forty-eight hours of hospitalization in a surgery unit are required. The extra-lesional excision is performed and a brachytherapy sheath is placed in the dermis plane. An iridium source with an initial activity of 300 GBq is used to deliver high dose rate brachytherapy. The brachytherapy sessions are held in a lead-shielded room in a radiotherapy unit: the first session at 6 h after surgical excision, while the second and third on the following day. The total dose administered is 18 Gy. A surgical workup is scheduled at 10 days. The patient is followed-up closely by the radiotherapist for an 18-month period. The recurrence rate after 2 years is 8 to 12%. The main complaints are dyschromia, telangiectasia and skin atrophy.