Treatment of Recurrent Earlobe Keloids with Surgery and High-Dose-Rate
Brachytherapy
Jugpal S. Arneja, MD, FRCS(C) 1, G. Balbir Singh MD, FRCS(C) 2, Kenneth
N. Dolynchuk, MD, FRCS(C) 2, Kenneth A. Murray, MD, FRCS(C) 2, Arlene A.
Rozzelle, MD, FACS 1 and Keith D. Jones, MD, FRCS (Eng), FRCR 3
1 Section
of Plastic Surgery, Children’s Hospital of Michigan and Wayne
State University
2 Section of Plastic Surgery, University of Manitoba
3 Section of Radiation Oncology, University of Manitoba
Introduction:
Recurrent keloids of the earlobe provide a challenging reconstructive and
aesthetic problem. Numerous modalities have been attempted to prevent
recurrence, with the use of radiation surfacing as the most effective post-excision
adjuvant treatment. High-Dose-Rate (HDR) brachytherapy is a form of radiation
delivery characterized by implantation of radioactive seeds through a hollow
catheter directly into a patient’s tumor site, the dose is calculated and delivered,
and the catheter removed.
Methods:
All cases of surgical excision followed by adjuvant HDR brachytherapy over a
five-year period were reviewed retrospectively. Figure 1 illustrates the treatment
protocol; keloid excision with in-situ HDR brachytherapy catheter placement,
primary or advancement flap wound closure over the catheter, computed
tomography planning, and immediate post-operative day 0, day 1, and day 2
HDR brachytherapy adjuvant therapy dosing (fractions: 500 cgy/dose/day).
Figure 1: Intraoperative excision of large right lobule keloid with closure over
brachytherapy catheter and CT scan treatment plan for three doses of
postoperative HDR brachytherapy (500Cgy/dose/day).
Results:
The mean age of twenty-five patients meeting inclusion criteria was 27.8 years
(range 15 to 59 years). There were 56% males and 44% females, primarily of
Caucasian descent (72%). The mean duration of keloid presence prior to
surgery was 26 months (range 14 to 55 months), while the mean keloid size was
4.7 cm2 (range 3.9 to 17.5 cm2). The mean follow-up interval was 35 months.
There was a 92% treatment success rate with success defined as no recurrence
of the keloid a minimum of two years post-operatively. Two patients had
complications of post-operative infection and subsequent keloid recurrence.
Conclusions:
Our results suggest our technique is efficacious, safe, well tolerated, and
successful at preventing recurrences with few complications at a mean 35-month
follow-up. However, we recommend this technique only for recurrent earlobe
keloids given the risk, albeit small, of radiation-induced malignancy. It is
imperative to discuss this risk with each patient and their family prior to initiating
therapy. HDR brachytherapy offers significant advantages over traditional
external beam radiation and with wide accessibility to HDR brachytherapy across
North America for the treatment of carcinomas and sarcomas, we feel that this
technique can easily be extrapolated by plastic surgeons and radiation
oncologists for the management of earlobe keloids.
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