Immediate high-dose-rate brachytherapy with volumetric planning for keloids: Clinical outcomes

To evaluate clinical outcomes and toxicity of a standardized protocol of immediate (<6 h postoperative) high-dose-rate (HDR) brachytherapy with volumetric planning in patients with keloids.

We conducted a retrospective cohort study including consecutive patients with histologically confirmed keloids treated with surgical excision followed by immediate (<6 h) HDR brachytherapy between April 2014 and November 2025. Treatment was delivered using a uniform fractionation scheme of 12 Gy in three fractions. CT-based planning was performed in all cases, and the clinical target volume (CTV) was defined over the surgical bed. Dosimetric analysis included D90 as the primary coverage parameter. The primary endpoint was local control (LC), defined as recurrence-free interval. Secondary endpoints included late toxicity (RTOG/EORTC) and patient-reported outcomes assessed using the POSAS 3.0 scale.

A total of 64 keloids were included. Median follow-up was 37.5 months. The overall local control rate was 92.2%, with five recurrences (7.8%), all occurring within the first 24 months. Median D90 was 98.5%. Larger lesions (>5 cm) showed a higher recurrence rate compared to smaller lesions (12.5% vs. 7.1%). No acute toxicity was observed. Late toxicity was limited to mild hypopigmentation (9.4%), grade one telangiectasia (6.3%), and superficial atrophy (4.7%). One case of mild chondritis (1.5%) was reported. Patient-reported outcomes demonstrated minimal residual symptoms and favorable aesthetic and functional outcomes, as reflected by the patient-reported POSAS scores CONCLUSIONS: Immediate (<6 h) HDR brachytherapy with volumetric planning provides high local control and favorable toxicity in keloid treatment. A regimen of 12 Gy in three fractions is feasible and well-tolerated, representing a valid option in the multidisciplinary management of keloids.