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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