Single-dose electron beam irradiation in treatment and
prevention of keloids and hypertrophic scars *

Theodore C.M. Lo, Brooke R. Seckel, Ferdinand A. Salzman and Kenneth A. Wright

Department of Radiation Oncology and Plastic and Reconstruction Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, U.S.A. and the High Voltage Research Laboratory, MIT, Cambridge, MA 02139, USA
published in Radiotherapy and Oncology 19 (1990): 267-272
Low megavolt electron beam irradiation was used on 354 sites in 199 patients at the Lahey Clinic either for palliation of symptomatic hypertrophic scars or as post-operative irradiation in an attempt to prevent formation or recurrence of hypertrophic scars. Electron beam energies used ranged from 1.5 MeV to 3.5 MeV. The median age of the 59 male patients was 22 years, and of the 140 female patients, 35 years. All patients had at least one follow-up visit, and the median follow-up was 35 months. Of the 294 sites treated for the first time, 272 (93%) were irradiated with a single fraction with a skin dose ranging form 2 to 20 Gy. Of the 85 sites in 63 patients without excision of symptomatic hypertrophic scars, single-dose electron beam irradiation was of clinically significant value in only 41 sites (48%). No patients have been treated without surgical excision since 1973. Because of a history of formation of hypertrophic scars elsewhere in the body, 13 patients with 19 incisions were treated prophylactically after operation for other diseases. All sites were irradiated with single doses ranging from 8 to 20 Gy, and hypertrophic scars did not subsequently develop in any patient. Altogether, 119 patients with 174 sites were irradiated after surgical excision of hypertrophic scars to prevent recurrence; 169 sites (97%) received single-fraction irradiation, and 161 received a dose of 8 Gy or greater, up to 15 Gy. No statistically significant differences were observed in complete success rates, ranging form 82% to 90% with doses of 9 Gy or greater. An interval of up to 72 hours between excision and single-fraction irradiation satisfactorily prevented recurrence, and clinically significant chronic telangiectasia was recorded in only one patient. No second malignant lesion was found in our series of patients followed up to 30 years. Postoperative low megavolt electron beam irradiation with a single dose of 9 Gy or greater is highly effective in the prevention of formation or recurrence of hypertrophic scars and keloids.
* Presented at the European Society of Therapeutic Radiology and Oncology 7th Annual Meeting in Den Haag, The Netherlands, September 4-8, 1988


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