Irradiation for Recurrent Keloid after Intial Surgery and Radiotherapy
In principle, this protocol should only be used after careful discussion with the consultant. It is always preferable to treat keloids after complete excision by plastic surgery teams. In all other cases of established keloid scars please discuss with the consultant if patient is not going to have surgery for any reason.
Direct low voltage irradiation is used. The PTV is the whole keloid, with 3 to 5 mm lateral margins. The energy used and focal skin distance chosen, is designed to encompass the maximum depth of the keloid within the 80% isodose of the treatment. For thin lesions, this will typically be 60 or 100 Kv photons. 2 mm lead shielding is required to protect skin in non-target areas.
Dose 16 Gy in 4# over 12 months or 16 Gy in 4# over 4 months.
Long duration protocols are used in young patients. This policy of extended treatment allows for patients who have made a good response following one or two treatments, not to continue and therefore to avoid unnecessary radiation dose. Patients must be reviewed prior to each fraction and set up seen by a clinician.