Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T11:15:07.577Z Has data issue: false hasContentIssue false
  • English
  • Français

Postoperative single versus multiple fractions high-dose rate iridium-192 surface mould brachytherapy for keloid treatment: a comparative study

Published online by Cambridge University Press:  20 June 2017

Misbah Ahmad ,
Habib Ahmad ,
Muhammad Rauf Khattak ,
Kamran Ali Shah ,
Nabila Javed ,
Syed Jawad Ali Shah ,
Wajeeha Shaheen  and
Kehkashan Mansoor
Misbah Ahmad*
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
Habib Ahmad
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
Muhammad Rauf Khattak
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
Kamran Ali Shah
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
Nabila Javed
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
Syed Jawad Ali Shah
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
Wajeeha Shaheen
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
Kehkashan Mansoor
Affiliation:
Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Khyber Pakhtun Khwa, Pakistan
*
Correspondence to: Misbah Ahmad, Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus , Peshawar, Khyber Pakhtun Khwa, Pakistan. Tel: +91922154. Fax: +919221223. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and purpose

In developing countries like Pakistan the cost effectiveness and patient convenience in any treatment modality is a question of major concern. The purpose of this study was two-fold; first to report our experience with a high-dose rate Iridium-192 surface mould brachytherapy of keloid scars after surgical excision, using different radiation treatment regimen and second to establish the most convenient and cost effective treatment protocol having no compromise on the treatment outcomes.

Materials and methods

From January 2012 to April 2015 a total 51 patients with 65 keloid lesions underwent postoperative Iridium-192 high-dose rate surface mould brachytherapy. The dose regimen used was: 8 Gy in a single fraction, 10 Gy in a single fraction, 15 Gy in three fractions and 18 Gy in three fractions. The median follow-up period was 33 months (range 15–53 months).

Results

The success rates were 57·2, 89·5, 85 and 89·5% for the treatment regimen of 8 Gy/F×1, 10 Gy/F×1, 5 Gy/F×3 and 6 Gy/F×3, respectively. Grade 2 or above radiation induced toxicity was not observed.

Findings

The results of this study show that a dose regimen of 10 Gy (biological effective dose=20 Gy) in a single fraction have comparable results with a dose regimen of 15 Gy in three fractions or 18 Gy in three fractions. 10 Gy in a single fraction is therefore the most convenient and cost effective dose regimen for the management of keloid scars in developing countries like Pakistan, while 8 Gy in a single fraction is considered suboptimal and discouraged in practice.

Keywords

brachytherapyhigh-dose rateiridium-192keloidsurface mould
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 1 , March 2018 , pp. 60 - 65
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kelly, A P. Medical and surgical therapies for keloids. Dermatol Ther 2004; 17 (2): 212–218.Google Scholar
2. Song, C, Wu, H G, Chang, H, Kim, I H, Ha, S W. Adjuvant single-fraction radiotherapy is safe and effective for intractable keloids. J Radiat Res 2014; 55 (5): 912–916.Google Scholar
3. Duan, Q, Liu, J, Luo, Z, Hu, C. Postoperative brachytherapy and electron beam irradiation for keloids: a single institution retrospective analysis. Mol Clin Oncol 2015; 3 (3): 550–554.Google Scholar
4. Ragoowansi, R, Powell, B W, Moss, A L, Cornes, P G, Glees, J P. Ear-lobe keloids: treatment by a protocol of surgical excision and immediate postoperative adjuvant radiotherapy. Br J Plast Surg 2001; 54 (6): 504–508.Google Scholar
5. Yosipovitch, G, Widijanti Sugeng, M, Goon, A. A comparison of the combined effect of cryotherapy and corticosteroid injections versus corticosteroids and cryotherapy alone on keloids: a controlled study. J Dermatol Treat 2001; 12: 87–90.Google Scholar
6. Rusciani, L, Rossi, G, Bono, R. Use of cryotherapy in the treatment of keloids. J Dermatol Surg Oncol 1993; 19: 529–534.Google Scholar
7. Bouzari, N, Davis, S C, Nouri, K. Laser treatment of keloids and hypertrophic scars. Int J Dermatol 2007; 46 (1): 80–88.Google Scholar
8. Apfelberg, D B, Maser, M R, Lash, H, White, D, Weston, J. Preliminary results of argon and carbon dioxide laser treatment of keloid scars. Lasers Surg Med 1984; 4: 283–290.Google Scholar
9. Poston, J. The use of silicone gel sheeting in the management of hypertrophic and keloid scars. J Wound Care 2000; 9 (1): 10–16.Google Scholar
10. Brent, B. The role of pressure therapy in management of earlobe keloids: preliminary report of a controlled study. Ann Plast Surg 1978; 1: 579–581.Google Scholar
11. Aköz, T, Gideroğlu, K, Akan, M. Combination of different techniques for the treatment of earlobe keloids. Aesthetic Plast Surg 2002; 26 (3): 184–188.Google Scholar
12. Narkwong, L, Thirakhupt, P. Postoperative radiotherapy with high dose rate iridium 192 mould for prevention of earlobe keloids. J Med Assoc Thai 2006; 89 (4): 428–432.Google Scholar
13. Sobec, R, Dobreanu, C, Fodor, L, Şomcutean, A, Ţichil, I, Cosgarea, M. Ear keloids: a review and update of treatment options. Clujul Med 2013; 86 (4): 313.Google Scholar
14. Klumpar, D I, Murray, J C, Anscher, M. Keloids treated with excision followed by radiation therapy. J Am Acad Dermatol 1994; 31 (2): 225–231.Google Scholar
15. Botwood, N, Lewanski, C, Lowdell, C. The risks of treating keloids with radiotherapy. Br J Radiol 1999; 72 (864): 1222–1224.Google Scholar
16. Ogawa, R, Yoshitatsu, S, Yoshida, K, Miyashita, T. Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis. Plast Reconstr Surg 2009; 124 (4): 1196–1201.Google Scholar
17. Recalcati, S, Caccialanza, M, Piccinno, R. Postoperative radiotherapy of auricular keloids: a 26-year experience. J Dermatolog Treat 2011; 22 (1): 38–42.Google Scholar
18. van Leeuwen, M C, Stokmans, S C, Bulstra, A E et al. Surgical excision with adjuvant irradiation for treatment of keloid scars: a systematic review. Plast Reconstr Surg Glob Open 2015; 3 (7): e440.Google Scholar
19. Guix, B, Henrı́quez, I, Andrés, A, Finestres, F, Tello, J I, Martı́nez, A. Treatment of keloids by high-dose-rate brachytherapy: a seven-year study. Int J Radiat Oncol Biol Phys 2001; 50 (1): 167–172.Google Scholar
20. Kal, H B, Veen, R E. Biologically effective doses of postoperative radiotherapy in the prevention of keloids. Dose-effect relationship. Strahlenther Onkol 2005; 181: 717–723.Google Scholar
21. US Department of Health and Human Services, National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE). Version 4.03, 14th June 2010. Washington, DC: US Government Publishing Office.Google Scholar
22. Garg, M K, Weiss, P, Sharma, A K et al. Adjuvant high dose rate brachytherapy (Ir-192) in the management of keloids which have recurred after surgical excision and external radiation. Radiother Oncol 2004; 73 (2): 233–236.Google Scholar
23. Arneja, J S, Singh, G B, Dolynchuk, K N, Murray, K A, Rozzelle, A A, Jones, K D. Treatment of recurrent earlobe keloids with surgery and high-dose-rate brachytherapy. Plast Reconstr Surg 2008; 121 (1): 95–99.Google Scholar
24. Kuribayashi, S, Miyashita, T, Ozawa, Y et al. Post-keloidectomy irradiation using high-dose-rate superficial brachytherapy. J Radiat Res 2011; 52 (3): 365–368.Google Scholar
25. van Leeuwen, M C, Stokmans, S C, Bulstra, A E et al. High-dose-rate brachytherapy for the treatment of recalcitrant keloids: a unique, effective treatment protocol. Plast Reconstr Surg 2014; 134 (3): 527–534.Google Scholar
26. De Cicco, L, Vischioni, B, Vavassori, A et al. Postoperative management of keloids: low-dose-rate and high-dose-rate brachytherapy. Brachytherapy 2014; 13 (5): 508–513.Google Scholar
27. Jiang, P, Baumann, R, Dunst, J et al. Perioperative interstitial high-dose-rate brachytherapy for the treatment of recurrent keloids: Feasibility and early results. Int J Radiat Oncol Biol Phys 2016; 94 (3): 532–536.Google Scholar
28. Veen, R E, Kal, H B. Postoperative high-dose-rate brachytherapy in the prevention of keloids. Int J Radiat Oncol Biol Phys 2007; 69 (4): 1205–1208.Google Scholar