From the Research
Superficial radiotherapy for keloids is most effective when administered after surgical excision rather than before, as it significantly reduces recurrence rates and improves patient outcomes. The recommended approach is to perform radiotherapy within 24-48 hours following keloid excision, ideally starting on the same day as surgery, as supported by the most recent study 1. A typical regimen includes fractionated doses of 15-20 Gy total, delivered in 3-5 sessions over 1-2 weeks.
Key Considerations
- Post-surgical radiotherapy works by inhibiting fibroblast proliferation and collagen synthesis during the early wound healing phase, which helps prevent keloid recurrence 2.
- The timing of radiotherapy is crucial because the radiation targets the actively dividing cells that would otherwise contribute to keloid formation.
- Pre-surgical radiotherapy is generally not recommended because it would not effectively target these cells and could potentially impair wound healing after the subsequent surgery.
- The combination of surgical excision followed by immediate radiotherapy has shown recurrence rates of only 10-20%, compared to much higher rates with surgery alone, as reported in a study published in 2021 3.
Treatment Protocol
- The use of superficial radiation therapy (SRT) with a low energy that targets the skin and spares deeper structures is ideal for keloid treatment, as noted in a 2025 study 1.
- A study from 2019 suggests that the maximal biologically effective dose (BED) for keloids is 30 Gy, and increasing the dose has no further benefits and elevates side effects 2.
- Patients should be informed that while this combined approach is effective, it requires prompt coordination between surgical and radiation oncology teams for optimal outcomes.
Outcomes and Quality of Life
- The treatment of keloids with surgical excision and postoperative radiotherapy can significantly improve patient outcomes, including reducing recurrence rates and improving quality of life, as supported by a study published in 2021 3.
- A study from 2016 reported excellent results in patients treated with surgical excision and immediate postoperative radiotherapy, with no major adverse events observed 4.