Radiation therapy in treatment of keloids:
Radiation therapy is an important component of treating cancers, however, it has also been used in treatment of non-cancerous conditions such as keloids. Purpose of radiation therapy in treatment of keloids is to reduce the chance of recurrence after a keloid is removed surgically.
Although addition of radiation to surgery does reduce the chance of recurrence, it does NOT totally prevent recurrence in all patients. The best results seen by using the method show 15-20% recurrence after surgery.
Although addition of radiation is advocated by many surgeons who operate on keloids, this method of treatment imposes serious risks to the patients. The most important concern about using radiation is its potential to cause long term complications such as cancer and damage to the organs and tissues near the site of radiation. The real concern about usage of radiation therapy in keloid patients is that majority of patients are very young, and radiation has long-term side effects. We need to remember that we are treating a patient, and not a keloid. We cannot risk the well being of a patient, expose her/him to long term carcinogenic effects of radiation, just to treat a keloid.
The graphs below show the age of onset and age at presentation of close to 1000 keloid patients, showing how young most keloid patients are.
Keloid Disorder - Age at Presentation
Keloid Disorder - Age of Onset
It is the opinion of Dr. Tirgan, shared by many others, that usage of radiation therapy for treatment of such a young and healthy population is completely inappropriate. Several decades ago, radiation therapy at even lower doses was used for the treatment of acne and fungal infections of the scalp. Although very effective, these practices were banned because of the documented increased risk of cancer among the treated patients.
The patient shown below, despite having had radiation, not only did not benefit from this intervention, but suffered from a much worse recurrence, and many other medical issues. This patient was a 23-year-old young man. As a result of several surgeries for his neck keloids, and additional radiation therapy he had to his neck, he developed this massive keloid that wrapped around his neck. Because of because of radiation induced fibrosis, he had lost his ability to move his neck to the point that he had to turn his torso to be able to look to the other side. Also, because of radiation therapy, and massive recurrence of his keloid, he had developed multiple abscesses under his keloid that would constantly get infected and drain pus.
Keep in mind that all keloids start as a small pimple, or a small bump on the skin. It is the wrong strategy that results in the nightmare that these patients have to live with for the rest of their lives.
Massive neck keloid formation following surgery and radiation therapy
The patient depicted below was treated with multiple surgeries and radiation therapy to her neck. As a direct result of the radiation therapy to her neck she developed hypothyroidism. She has now to take thyroid supplementation for the rest of her life. She is also at much increased risk of developing thyroid cancer from the radiation.