Original Paper

European Journal of Plastic Surgery

, Volume 36, Issue 5, pp 289-294

Adjunctive treatment of keloids: comparison of photodynamic therapy with brachytherapy

  • Harie BasdewAffiliated withDepartment of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Erasmus University Medical Center
  • , Robert MehilalAffiliated withDepartment of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Erasmus University Medical Center
  • , Abrahim Al-MamganiAffiliated withDepartment of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Erasmus University Medical Center
  • , Peter van RooijAffiliated withDepartment of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Erasmus University Medical Center
  • , Anand BhawanieAffiliated withDepartment of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Erasmus University Medical Center
  • , Henricus J. C. M. SterenborgAffiliated withThe Center for Optical Diagnostics and Therapy, Department of Radiation Oncology, Erasmus MC, Erasmus University Medical Center
  • , Rudi Tjong Joe WaiAffiliated withDepartment of Plastic and Reconstructive Surgery, Maasstad Ziekenhuis
  • , Marc MureauAffiliated withDepartment of Plastic and Reconstructive Surgery, Erasmus MC, Erasmus University Medical Center
  • , Dominic J. RobinsonAffiliated withThe Center for Optical Diagnostics and Therapy, Department of Radiation Oncology, Erasmus MC, Erasmus University Medical Center
    • , Peter C. LevendagAffiliated withDepartment of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Erasmus University Medical Center Email author 

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Abstract

Background

The aesthetic result after brachytherapy, especially hypopigmentation, remains a significant problem. Given that brachytherapy may be carcinogenic, it is difficult to recommend this treatment in young patients. For these reasons, there is a need for alternatives to radiation.

Methods

The purpose of this study was to evaluate the effectiveness of adjuvant photodynamic therapy (PDT) using aminolevulinic acid after keloid excision and to compare it to keloid excision followed by brachytherapy. To assess outcome, the Patient and Observer Scar Assessment Scale (POSAS) was used.

Results

Thirty-four patients treated for 45 keloids were evaluated. Twenty-two patients (27 lesions) received brachytherapy and 12 (18 lesions) received PDT. The observers scored a mean POSAS of 19.1 (range 13.0–34.0) for brachytherapy and 24.6 (range 11.0–37.0) for PDT (p = 0.005). The independent observers scored a mean POSAS of 14.6 (range 10.0–20.0) for brachytherapy and 18.6 (range 9.0–42.0) for PDT (p = 0.018). The patients reported a significantly better mean POSAS score after brachytherapy (22.8, range 7.0–53.0) than following PDT (34.2, range 11.0–63.0). The patients’ POSAS score showed no significant difference for the item “general impression” for both treatment groups; the observers scored significantly higher for PDT treatment. The independent observers revealed a higher score for general impression after PDT although not reaching significance.

Conclusions

Patients and observers appear to be more satisfied with the results after brachytherapy than PDT. However, patients still have a positive general impression after PDT. Adjunctive aminolevulinic acid–PDT for the treatment of keloids could be used as an alternative for brachytherapy.

Level of Evidence: Level IV, therapeutic study.

Keywords

Brachytherapy Keloid Aminolevulinic acid Photodynamic therapy POSAS