Keloid

Question 1

Work up

Answer 1

Surgery, kenalog injections. RT if recurrence. Avoid second cancer risk

Question 2

Dosing

Answer 2

“4 Gy x 3 fx=12 Gy
or 6 Gy x 3 fx =18 Gy for BED >30 (Dutch)
Or 5 Gy x 5 fx =20 Gy for BED>60 (Allegheny)
Perform same day of surgery–or as soon as possible”

Question 3

Fields

Answer 3

1.5-2 cm margin, 6 MeV energy, 0.5 cm bolus, Rx to 90 percent

Question 4

Outcomes

Answer 4

Try to do RT same day of surgery

“Surgery alone LR: 50-80
with steroids LR 50%
with RT reduced to <10% if BED>30 Gy”

Question 5

Surgical Options

Answer 5

Excision followed by kenalog injections