32. Keloids - The GEC-ESTRO Handbook of Brachyterapy

Keloids

7

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

TABLE 32.1 LISTS DIFFERENT HDR DOSE SCHEDULES AND FRACTIONATION REGIMENS WITH CORRESPONDING BED AND EQD2 (α/β VALUES OF 10 GY) Author Patients/Keloids (N) Brachytherapy Method Local recurrence (%) Good cosmetic results (%)

Ir LDR 12- 15 Gy

Clavere [26]

43 / 51

Unknown

35

88

Ir LDR 20 Gy

Escarmant [3]

43 / 51

Interstitial

21

80

Ir LDR 15-20 Gy

Gerbaulet [27]

157 / 201

Unknown

25

75

Ir LDR 20 Gy

Malaker [16]

30

Interstitial

17

Ir LDR 15-20 Gy

Nicoletis [13]

20

Unknown

15

Sr/Y HDR 14 Gy (1x 14 Gy) Ir HDR 18 Gy (unknown) Ir HDR 18 Gy (3x6Gy) 5mm Ir HDR 12-18 Gy (3x4 -3x6Gy) 5mm

Wagner [14]

139 / 166

Contact

20

80

Arnault [28]

87/138

Unknown

23.6

Ns

Jiang [29]

29/29

Interstitial

17

91

Bijlard [19]

149/226

Interstitial

8,3

Ns

Ir HDR 12 Gy 5mm

Barragan [18]

51/61

Interstitial

4.9

81

C0 60 HDR 15 Gy (3x5 Gy) 5mm

Manjunath [20]

50/71

Interstitial

4%

NS

HDR 12 Gy (3x4Gy)

Fuenmajor [22]

14/14

Mould

21%

NS

Ir HDR 8 Gy (1x 8Gy) 5mm Ir HDR 18 Gy (3x 6 Gy) 5mm Ir HDR 15 Gy Gy (3x5 Gy) Ir HDR No surgery 18 Gy 6x3 Gy Surgery 12 Gy 4x3 Gy 10mm Ir HDR

Anderson [12]

14/20

Interstitial

0

NS

Daurade [30]

38/67

Interstitial

6%

62

Bautista [23]

80/85

Mould

5

90

Kuribayashi [21]

21/36

Mould / Contact

9.7

NS

13.6 4

77 97

Guix [17]

169

Mould / Interstitial

Interstitial LDR – Brachytherapy Escarmant et al (8) published one of the largest patient populations for LDR. 570 patients were retrospectively studied. The average dose given was 19.14 Gy (range 8-30 Gy). The recurrence rate was 21% with disappearance or reduction in symptoms in 80% of cases, and good cosmetic results in 75% of patients. Other authors as Malaker and Nicoletis reported recurrence rates of 15-17% with dose of 20 Gy [13, 16]. Interstitial HDR – Brachytherapy Guix [17] published an HDR patient collective of 169 patients with a recurrence rate of 4% for the combined surgery and BT treated patients. For the patients treated with brachytherapy without surgery the recurrence rate was 13.6%. Barragan [18] reported a 5% recurrence rate with perioperative brachytherapy.

Bijlard et al. [19] reported the data of 3 different fractionation schedules with a recurrence rate of 8.3% for interstitial brachytherapy using 1 catheter in 5 mm depth. Manjutnath et al used Co-60 instead of Ir-192 and reported a recurrence rate of 2% after 5 months [20]. Overall, the local recurrence rate is between 2.4% and 20% and good cosmetic results are obtained in 60% to 91%. Superficial HDR – Brachytherapy Kuribayashi et al. [21] report recurrence rates of 9.7% for superficial brachytherapy with a dose of 3-4 x 5 Gy and a total dose of 15-20 Gy. The authors used 2 plastic tubes with a spacer to achieve a distance of 3 mm to the skin. The recurrence rate in keloids of the earlobes also treated with surface therapy was 21% reported by Fuenmayor et al. [22] Bautista Hernandez et al. [23] observed a recurrence rate of 5%