Treatment/Prognosis Flashcards
What are the indications for RT in keloid Tx?
The indications for RT in keloid Tx include demonstrated recurrence after resection, marginal or incomplete resection, an unfavorable location, a larger lesion or after keloid management is refractory to nonsurgical options such as corticosteroid injection, laser, or cryotherapy.
Within what time frame should RT be given postop after keloid resection?
PORT for keloids should be initiated within 24 hrs after resection.
What is the typical target RT volume for keloid Tx?
The typical target RT volume for keloid Tx is scar + a 1- to 1.5-cm margin.
What is the typical RT dose and fractionation for keloids?
The typical RT dose and fractionation for keloids is 15–18 Gy in 3–4 fx. Single doses of 7.5–10 Gy are also effective. (Ragoowansi R et al., Plast Reconstr Surg 2003) Some series suggest that a dose of at least 9 Gy is required to maximize the benefit from RT. (Lo T et al., Radiother Oncol 1990; Doornbos J et al., IJROBP 1990) Another series from Pittsburgh suggests that doses of at least 5–6 Gy/fx for 3 fx may be needed for 90%–95% control for earlobe keloids and 7–8 Gy/fx for 3 fx may be needed for similar control at other sites. (Flickinger J, IJROBP 2011)
What RT modalities can be used in the Tx of keloids?
For RT Tx of keloids, the most common modalities are lower megavoltage electrons, kilovoltage photons, or brachytherapy.
Name 7 Tx options for keloids other than Sg and RT.
Tx options for keloids other than Sg and RT include steroid injections, pressure earrings, silicone gel sheeting, cryosurgery, laser therapy, imiquimod, and injections of fluorouracil or verapamil.
What is the recurrence rate for keloids after PORT?
The recurrence rate for keloids after PORT is typically 10%–35%. This can vary depending on the size, location, extent of excision, etiology, and other factors.
Is there any randomized data comparing Sg + RT against Sg + steroid injection?
Yes. A prospective randomized trial conducted by Sclafani A et al. looked at a series of 31 pts, comparing PORT vs. intralesional steroid injection. The recurrence rate after Sg + RT was 12.5%; the recurrence rate after Sg + steroid injection was 33%. (Dermatol Surg 1996)
For unresectable keloids, what is the efficacy of using RT alone?
Malaker K et al. looked at 86 keloids in 64 pts treated with RT alone. 97% had significant regression 18 mos after completing radiotherapy. 63% of the pts surveyed were very happy with the outcome of their Tx. (Clin Oncol 2004)
