From the Guidelines
Radiotherapy should ideally begin within 3-6 weeks after keloid excision to allow acute reactions to subside and decrease the risk of wound complications, as evidenced by the NCCN clinical practice guidelines in oncology 1. When considering the timing of radiotherapy after keloid excision, it is essential to prioritize wound healing and minimize the risk of complications.
- The NCCN guidelines suggest that preoperative RT may reduce seeding during surgical manipulation of the tumor, but it also affects wound healing, necessitating a 3- to 6-week interval before resection 1.
- This interval allows acute reactions to subside, reducing the risk of wound complications and promoting optimal healing.
- While prompt initiation of radiotherapy is crucial in some contexts, the specific scenario of keloid excision requires careful consideration of wound healing to minimize complications and ensure the best possible outcomes.
- The involvement of a plastic surgeon in the team may be necessary to reduce wound complications when preoperative RT is contemplated, as noted in the NCCN guidelines 1.
- Ultimately, the decision on when to start radiotherapy after keloid excision should be made on a case-by-case basis, taking into account the individual patient's needs and the potential risks and benefits of different timing strategies, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Timing of Radiotherapy after Keloid Excision
- The optimal timing for starting radiotherapy after keloid excision is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it can be inferred that radiotherapy should be started shortly after keloid excision, as the goal of adjuvant treatment is to prevent recurrence of the keloid 3.
- The study by 2 discusses the evolution of their radiotherapy protocol for keloid excision wounds, but does not specify the exact timing of when to start radiotherapy after excision.
- It is essential to note that the provided studies focus on the efficacy of different treatments for keloids, including radiotherapy, rather than the specific timing of when to start radiotherapy after excision 2, 3, 4, 5, 6.
Considerations for Radiotherapy Protocol
- The radiotherapy protocol for keloid excision wounds may vary depending on the body site and the risk of recurrence 2.
- The study by 2 suggests that higher doses of radiotherapy may be necessary for body sites that are highly prone to recurrence, such as the anterior chest.
- In contrast, lower doses of radiotherapy may be sufficient for body sites with lower recurrence rates, such as the earlobe 2.
- The choice of radiotherapy protocol should be individualized based on the specific characteristics of the keloid and the patient's overall health status 3.