radiotherapy for keloid

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. Radiotherapy for Keloids
Dr Mohammad Abu Ashoor
Radiation oncologist
MCAC / RMS

3. Definition and Clinical Features
• Keloids are excessive tissue formation in the
region of scars, and they may occur in case of
skin injury from surgery, burns, chemical
burns, or inflammation (e.g., acne) or even
spontaneously.

4. • Keloids appear mostly in the upper body and
in regions with high skin tension (e.g., above
the sternum, at the earlobes, and in the joint
regions).
• The cause of the disorder is still
undetermined, but there is a genetic and race-
specific predisposition.

8. Keloids VS Hypertrophic Scars
• They differ from hypertrophic scars by their
infiltrating character, causing local pain and
inflammation reactions.
• Hypertrophic scars show thickening without
surrounding reaction and can flatten
spontaneously.
• Keloids are hypertrophic scars in which
collagenous tissue is overproduced and grows
beyond the original dimensions of the wound.

10. Nonradiotherapeutic Treatment
• Besides surgical excision of hyperplastic tissue
with cosmetic disfigurement and functional
disruptions, it is possible to use a conservative
procedure with pressure and silicon bandages,
steroids cream, or steroid injections ,
Cryotherapy , laser.
• In more than 50% of cases, there is local
recurrence after excision of keloids alone.

11. •SO WE NEED
RTX ;)
• Surgery + RTX = less than 25 / 15 / 2 %

12. WHEN ?????????
• THE SOONER THE BETTER !!!!!
• 1-2 weeks.
• Within 72 hours . ( > 72 hrs increase the
recurrence )
• 24 – 48 hours after excision.
• The ideal time post op has been shorten to 7
hours in some studies.
• Same day surgery.

13. How ???
• EBRT.
• Brachytherapy.

14. Dose ??
• Kal and Veen reported that for biologically
effective dose (BED) values greater than 10 Gy,
the keloid recurrence rate decreased as a
function of BED.
• The authors gathered dose response data from a
literature , and recommend a BED value of 30 Gy
(single fraction 13 Gy, two fractions of 8 Gy, or
three fractions of 6 Gy), which resulted in a
recurrence rate less than 10%.

15. • 8 Gy / 1 fx
• 12 Gy / 3fx ( ear , face = cosmetic reason )
• 16 Gy/ 2 fx
• 18 Gy/3 fx (ear lobe )
• 20 Gy /4 fx ( chest , trunk high recurrance )
• 21 Gy / 3 fx

16. The technique
• The re-excision incision, plus a 1- to 2-cm
margin, is treated. All suture sites should be
included , or 6- to 10-meV electrons at 90 %
IDL .
• 0.5 to 1.0 cm of bolus can be used so that the
most superficial tissues are not under dosed.

19. RTX alone !
• Definitive RT dose is 37.5 Gy/5 fx.

20. Thank you !!!