As many of these patients are young, and will live long enough to experience potential late radiation toxicity, this must be discussed specifically when obtaining signed consent. The information given must be recorded in the case notes. No patients under 16 years old will be consented without the presence of a parent or guardian. It is advisable to involve the paediatric radiotherapy consultant when considering treatment for younger patients.
These patients are treated jointly with the plastic surgery team. Radiotherapy is given to the operative site within 24 hours after operation. (In exceptional cases 48 hours may be permitted). This requires close liaison: if there are no free treatment spaces within 24 hours of the suggested operation time, inform the surgeons at once, so that operation dates can be altered.
Direct low voltage photon irradiation is used. The PTV is the whole operative scar including suture sites, with 0.5 cm margin and is treated with 60 kV photons. If the scar extends to both sides of the earlobe target volume is treated with 160 kV photons with additional lead shielding for exit dose.
Please remember that the treatment volume will need to be greater, due to fall-off in dose at field edges. This effect is more pronounced in long, narrow fields. Ask advice from physics if you are unsure what extra margins to allow in positioning the lead shielding.
All keloid scars are treated as ‘mark on set’. 2 mm lead shielding is required to protect skin in non-target areas.
10 Gy in one single fraction (applied dose).
It is necessary for a clinician to be present at time of treatment to see the set up and correct for stand off. Patients are reviewed in clinic 6-8 weeks later and then discharged after a clinical photograph. Patients are not routinely followed but are advised to return to the radiotherapy clinic if they are concerned about recurrence.