Optimising post-surgical radiotherapy for keloid prevention: timing, dose, and technique
Keloid scars can be distressing, uncomfortable and difficult to treat. For individuals prone to keloid formation, surgical removal alone is often not enough, as the scar may return and sometimes grow larger than before.
In this article, radiotherapy specialist and clinical oncologist Dr Richard Shaffer explains how post-surgical radiotherapy for keloid prevention can significantly reduce the risk of recurrence, focusing on the key principles of timing, dose and treatment technique.
What is a keloid scar?
A keloid is an overgrowth of scar tissue that develops when the skin’s healing response becomes excessive after injury or surgery. Unlike normal scars, keloids extend beyond the original wound and do not regress over time. They may cause itching, pain, tightness or cosmetic concern.
Keloids are more common on the chest, shoulders, upper back and earlobes, and occur more frequently in people with a personal or family history of abnormal scarring.
Why use radiotherapy after keloid surgery?
Radiotherapy after keloid surgery is used to reduce the activity of fibroblasts, the cells responsible for excessive scar formation. When combined with complete surgical excision, radiotherapy significantly lowers recurrence rates compared with surgery alone.
The treatment is highly localised and uses much lower radiation doses than those used in cancer care. Its purpose is not to treat disease, but to regulate the healing process in the scar bed.
Timing of post-surgical radiotherapy
Radiotherapy is most effective when delivered as soon as possible after surgical excision, ideally within 24 hours, and no later than 72 hours. Scar-forming cells begin multiplying very early in the healing process, and timely radiotherapy interrupts this activity before excessive collagen production becomes established.
Close coordination between the surgical and radiotherapy teams is essential to ensure treatment is delivered within this optimal window.
Radiotherapy dose for keloid prevention
Keloid prevention requires relatively low doses of radiation, typically delivered over one to three short treatment sessions. The exact dose and fractionation depend on factors such as scar location, size and previous recurrence.
The goal is to suppress abnormal scarring while minimising exposure to surrounding healthy tissue.
Radiotherapy techniques used for keloids
Commonly used techniques include superficial X-ray therapy and electron beam radiotherapy. These methods are designed to treat the skin surface only, without affecting deeper tissues or organs.
Custom shielding and precise planning help ensure radiation is confined to the scar area. Treatment sessions are painless and usually last only a few minutes.
Is radiotherapy for keloids safe?
When appropriately selected and delivered, radiotherapy for keloid prevention is considered safe and well tolerated. Short-term side effects may include mild redness or temporary skin pigmentation changes. The risk of serious long-term complications is extremely low, particularly with modern techniques and low-dose protocols.
Post-surgical radiotherapy is a highly effective strategy for keloid prevention when delivered at the right time, using the correct dose and technique. Early discussion with a specialist is particularly important for patients at higher risk of keloid recurrence.
