Reply: High-dose-rate brachytherapy for the treatment of recalcitrant keloids: a unique effective treatment protocol.

Abstract

Sir: We have read with interest the letter of Drs. Long and Wang. First, we would like to confirm the addressed comments of the authors. Patient 34 did not receive previous treatments and should have been excluded. Problems with hypopigmentation and hyperpigmentation were seen in six of 35 scars, instead of 35 patients. Second, the protocol described in our article is only applicable if the wound can be closed primarily following excision of the lesion. This is required to enclose and fixate the brachytherapy catheter (see Fig. 1 of the article1). It is therefore impossible to apply brachytherapy to large keloids that cannot be closed primarily. These scars, however, could be closed with a skin graft, after which external irradiation can be applied as described in the protocol of Dr. Li et al.2 Finally, Drs. Long and Wang discussed the possibility of bias, because three patients did not complete the treatment protocol. However, the three patients were excluded from the results. Therefore, no bias was possible. Thus, when looking into Figure 2 of the article, 32 keloid scars completed the treatment protocol, with a recurrence rate of 3.1 percent. We agree with Drs. Long and Wang that larger randomized studies are more than welcome. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Michiel C. E. van Leeuwen, M.D. Department of Plastic and Reconstructive Surgery VU University Medical Center Amsterdam, The Netherlands Suzanne C. Stokmans, M.D. Department of Surgery University Medical Center Groningen Groningen, The Netherlands Anne-Eva J. Bulstra, B.Sc. Department of Plastic and Reconstructive Surgery VU University Medical Center Amsterdam, The Netherlands Otto W. M. Meijer, M.D. Department of Radiation Oncology VU University Medical Center Amsterdam, The Netherlands Paul A. M. van Leeuwen, M.D., Ph.D. Department of Experimental Surgery VU University Medical Center Amsterdam, The Netherlands Frank B. Niessen, M.D., Ph.D. Department of Plastic and Reconstructive Surgery VU University Medical Center Amsterdam, The Netherlands