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.

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Keywords Aminolevulinic acid, Brachytherapy, Keloid, Photodynamic therapy, POSAS
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Journal European Journal of Plastic Surgery
Bos, C.S, Mehilal, R, Al-Mamgani, A, van Rooij, P.H, Bhawanie, A, Sterenborg, H.J.C.M, … Levendag, P.C. (2013). Adjunctive treatment of keloids: Comparison of photodynamic therapy with brachytherapy. European Journal of Plastic Surgery, 36(5), 289–294. doi:10.1007/s00238-012-0794-z