Keloids are the result of excessive fibroblast proliferation and then over-abundant collagen deposition. In spite of the several treatment modalities available, there is no method able to guarantee absolute success in the therapeutic approach to keloids.The use of radiotherapy (teletherapy and brachytherapy) after surgery is well documented and results are promissory. Our case report involves a female patient with three lesions in her back (Q1, Q2 and Q3) and another one in the posterior neck behind the ear (Qra), treated with a silicon patch with 32P (Silibraq®). Pre-treatment and adjuvant treatment of the lesions were performed with Thiomucase, 5-fluoruracile, procaine and triamcinolone. Measurements of the lesions were taken and the patch was specially designed for its application on each lesion surface with minimal contact with the normal surrounding tissue. Taking into account the activity contained in each of the patches and the total radiation dose to administer according to clinical practice, dosimetric calculations were done for each lesion using the following equation:
| D (o) = |
œ As x Ēβ x 1.6 10-6 erg/Mev x 3.7 1010 des/seg Ci
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|
Rβx δx 100 erg/g Rad
|
As s: activity per surface.
Ēβ: median β energy.
Rβ: maximum range.
δ: tissue density (assumed as water = 1g/cm3).
All keloid scars were controlled at 2 months of follow-up. Q1 has total remission within 2 months of treatment. Last follow-up visit (6 months after therapy) revealed that Q2 achieved a partial remission by reducing its size up to 80% and Q3 achieved total remission. Qra reduced its size up to 50% of the original within 1 week after therapy with 32P and a partial a partial remission of 70% was achieved 2 weeks after patch application. Erythema and hyperpigmentation developed after the treatment of the keloids but were successfully controlled.This case report confirms the efficacy of this modality treatment of keloids. Total remission was achieved in two treated lesions within 2 and 6 months of follow-up and the other two lesions resulted in 70-80% reduction of their size within 6 and 2 months, respectively.
