Kamal Malaker, Presenter: Nothing to Disclose

Vijay K. Raghavan, Abstract Co-Author: Nothing to Disclose

Ian Hodson, Abstract Co-Author: Nothing to Disclose

Al Yafi Tawfik, Abstract Co-Author: Nothing to Disclose

Purpose/Objective: To analyse retrospectively, the therapeutic response of patients with keloids who were treated definitively by radiotherapy over a period of more than 25 years in two institutions. Due to keloid size, location or recurrence following multiple surgical excisions, rendered these patients unsuitable for further surgical excision and postoperative radiotherapy. Materials/Methods: Between 1977 and 2004, in two major academic radiation oncology centres, 86 keloids were treated in 64 patients. 26 patients were male and 38 female, aged between 18 and 58 years. The most common site was on the abdomen at post laparotomy sites (21/86). A close second was post vaccination sites on the upper limbs (20/86). Other common sites at presntation were post surgical scars on the pelvis (13/86) and post sternotomy scars on the chest wall (12/86). Others were scattered throughout the body, with signifiantly fewer on the lower limbs. Prior to delivering radiotherapy the keloid-cutaneous junction was marked. A second marking was made 2 mm away from the keloid-cutaneous junction if the lesion was treated by x-rays, and 1.5 - 2 cm is the lesion was treated by electron beams. A lead cut-out was made along the second marking which was the treatment port. Between 100 and 250 KV x-rays and 6 to 9 MeV electrons were used. A direct skin opposition field was used with appropriate wax build up for electrons. They were given 3500 cGy at D max in 5 weekly fractions i.e., 750 cGy per fraction in 5 weeks. The TDF for this regimen is 99, whereas TDF for normal skin tolerance is 112. The BED conversion is 100 and 117 respectively, giving this regimen a biological advantage. Radiation induced cell death, we presume, is an important factor for keloidal regression in this study. However keloids mostly contain biologically inert, poorly vascularised proteinous collagens. The role of radiolysis as another dominant factor which may have an important role in the regression of keloids in this study, will be elaborated. Results: All the lesions responded with some form of regression. At 24 weeks 90% of the treated lesions regressed completely and 10% partially. The rate of follow up attendance gradually diminished. By 76 weeks or 18 months 70 treated lesions had documented follow up, 68/70 showed complete regression (97%) and 2/70 (3%) partial regression. By 5 years only 36 lesions had documented follow up and all 36 lesions (100%) had complete regression. The most common side effect was epilation. There was complete (100%) epilation of the treated area which lasted throughout the follow up period. Pigmentation was the next significant side effect, affecting 93% by 2 weeks reducing to only 12.5% by 76 weeks. Other side effects included dry desquamation, atrophy and telengiectesia. None of the patients who were followed up for 5 years or more, developed any form of malignancy. 64% of patients were very satisfied, 25% were satisfied and 11% 'could live with' the cosmetic outcome of their treatment. Further details of the rationale, materials and methods and the analysis of results will be presented. Conclusions: It appears that the above treatment is effective in resolution of unresectable keloids without any short term or long term complications.

Malaker, K, Raghavan, V, Hodson, I, Tawfik, A, Definitive Radiotherapy for Unresectable Keloids.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4417925.html