Is Radiation Therapy for Keloids Acceptable? The Risk of Radiation-Induced Carcinogenesis

@article{Ogawa2009IsRT,
  title={Is Radiation Therapy for Keloids Acceptable? The Risk of Radiation-Induced Carcinogenesis},
  author={Rei Ogawa and Sumiko Yoshitatsu and Ken Yoshida and Tsuguhiro Miyashita},
  journal={Plastic and Reconstructive Surgery},
  year={2009},
  volume={124},
  pages={1196-1201}
}
Background: Keloids have been treated by using radiation for over a century, and it is currently suggested that keloids are best treated by a combination of surgery and postoperative radiation therapy, although randomized controlled trials testing this are still lacking. However, plastic surgeons tend to avoid radiation therapy for keloids for fear of inducing malignant tumors. Thus, the authors searched for previous reports of associations between carcinogenesis and keloid radiation therapy… 
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References

SHOWING 1-10 OF 52 REFERENCES
Biologically Effective Doses of Postoperative Radiotherapy in the Prevention of Keloids
TLDR
The results of this study indicate that for effectively treating keloids postoperatively, a relatively high dose must be applied in a short overall treatment time.
Keloids treated with excision followed by radiation therapy.
The treatment of 783 keloid scars by iridium 192 interstitial irradiation after surgical excision.
Prevention of Earlobe Keloid Recurrence with Postoperative Corticosteroid Injections Versus Radiation Therapy A Randomized, Prospective Study and Review of the Literature
TLDR
Although a statistically significant difference was not observed, radiotherapy appeared to be more effective than steroid injections in preventing keloid recurrence, and patients were much more likely to complete treatment than with corticosteroid injections.
Postoperative interstitial radiotherapy of keloids by iridium 192: a retrospective study of 46 treated scars.
TLDR
Postoperative interstitial radiotherapy represents an effective, unconstraining and safe treatment for keloids if the contraindications are respected.
The risks of treating keloids with radiotherapy.
TLDR
A case of a patient who developed bilateral breast carcinomas almost 30 years after treatment of chest wall keloids with radiotherapy is reported, indicating the safety of this approach to the management of keloid scars.
Combined Surgical Excision and Radiation Therapy for Keloid Treatment
TLDR
The combined treatment of surgical excision and postoperative electron beam irradiation is effective for scar quality and reducing the recurrence rate in long-term follow up.
Superficial X‐Ray Therapy in Keloid Management: A Retrospective Study of 24 Cases and Literature Review
TLDR
It is concluded that superficial x-ray therapy does reduce the rate of postexcisional keloid recurrence, and the need for better controls in reporting on superficialx-ray Therapy in keloids management is stressed.
Radiotherapy in the Management of Keloids Clinical Experience with Electron Beam Irradiation and Comparison with X-Ray Therapy
TLDR
Electron radiation therapy is superior to kilovoltage irradiation for treating keloids due to better dose distribution in tissue, and therefore less radiation burden to the organs at risk.
Role of ionizing irradiation for 393 keloids.
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