32. Keloids - The GEC-ESTRO Handbook of Brachyterapy

Keloids

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 11/04/2025

32 Keloids

Peter Niehoff, Erik Van Limbergen

1. Summary 2. Introduction

3 3 3 4 4 4 5 5

9. Dosimetry

6 6 6 6 8 8 9

10. Dose, dose rate and fractionation

3. Anatomical Topography

11. Monitoring

4. Pathology 5. Work up

12. Results

13. Adverse Events 14. Key messages 15. References

6. Indications, Contra-indications 7. Tumour, target volumes and organs at risk

8. Technique

1. SUMMARY

Keloids, characterized by abnormal scar tissue growth beyond the wound boundaries, pose both cosmetic and functional challenges for patients. This chapter explores the utilization of brachytherapy in the treatment of keloids, an evolving therapeutic approach aimed at addressing the underlying pathophysiological mechanisms of keloid formation. Brachytherapy involves the precise delivery of localized radiation to the keloid tissue. The rationale lies in its ability to modulate fibroblast activity, inhibit collagen synthesis, and impede cellular proliferation. This targeted radiation approach is designed to minimize damage to surrounding healthy tissues. The success of treatment may be influenced by factors such as radiation dose, duration, and patient-specific variables such as bleeding and infection.

2. INTRODUCTION

• Laser, prolonged local compression (several months), retinoic acid or silicone gel, but results are not very encouraging. • Cryotherapy in combination with glucocorticoids • Post-operative radiotherapy (external beam, orthovoltage, electrons or brachytherapy) following excision of a keloid is regularly used to prevent the keloid regrowing and even non-excised keloid lesions can be reduced in thickness with a fractionated course of radiotherapy [2].

Keloids are benign tumours of the skin that most commonly occur after a local injury to the skin. In rare cases they can occur after microtraumas such as insect bites or medical injections. Typically, a keloid scar can appear after a local trauma: surgical excision, ear piercing, vaccination, skin burn or infection. Keloids occur mainly in the Asian and African coloured population. There is also a familial genetic predisposition to keloid growth [1]. Keloids should be distinguished from hypertrophic scars, which have a better prognosis. While hypertrophic scars are always limited to the area of injury, keloids grow beyond the incision or trauma area. Preferential locations are the ears, the presternal and the deltoid region. In addition to the high psychological burden due to the unattractive cosmetic appearance, especially in the facial area, patients often suffer from burning, pain, itching or tingling. A variety of treatments can be used: • Surgery alone, the risk of local recurrence is about 2/3 of the cases after surgery alone. • Surgery followed by post operative injection of corticosteroids. The risk of recurrence remains high in about a third of the patients [2].

3. ANATOMICAL TOPOGRAPHY

Keloids can appear in the skin everywhere on the body (Fig. 32.1 and 32.2). However, they are most common on the auricles or in areas of the body with high skin tension, such as deltoid region, scapula or sternum area. Improvement of cosmetic appearance is the main reason for treating a keloid, the resulting cosmetic effect of re excision (always a longer scar) must be anticipated before a decision for treatment is taken. Also, the presence of radiosensitive tissues in the neighbourhood of the keloid must be critically evaluated. [3, 4].