The treatment of 783 keloid scars by iridium 192 interstitial irradiation after surgical excision

Keloids are frequent in Martinique; for a population of 360,000, we treat on average 6 keloids per month, and not all are passed on to us. Between 1977 and 1988, 544 patients (of whom 97% were of mixed race), with a total of 855 keloids, were treated by interstitial radiotherapy immediately following total excision. Recurrence rate is 21%, as against 50 to 80% for surgery alone, according to most authors (depending on whether or not surgery was accompanied by a postoperative injection of corticosteroids). This recurrence rate is about the same as for external radiotherapy, but we prefer our method for practical reasons (cost, equipment, radiobiology, technique). 90% of recurrences occurred in the year following therapy, which proves that a follow-up time of at least twelve months is needed for a study of keloids, or even 18 months according to some authors. In our experience, the keloids that are the most likely to recur are the largest and those giving rise to most symptoms. Bruising and loosened stitches, but in particular infection during therapy, largely favour a recurrence, and in any case jeopardize a good cosmetic result. In our series, the symptoms disappeared or were much improved in 80% of cases, and the cosmetic result was judged good by 75% of the patients