title: Radiotherapy following surgery in keloid treatment: our protocol.
abstract: BACKGROUND
  Despite the wide availability of literature on keloids, their onset is not completely understood. Several protocols have been described to treat keloids, but none are considered to be a gold standard. In this paper, we will report our experience treating recurrent keloids with surgical excision, followed by immediate postoperative radiotherapy, focusing on the irradiation protocol, to better define the treatment schedule, dose, and results.
  
  
  METHODS
  From September 2009 to July 2012, 10 patients were referred to our department because of unresponsive keloids. All patients underwent 6-MeV electron beam radiotherapy, up to a total dose of 20 Gy, 24-48 hours after radical surgical keloid excision.
  
  
  RESULTS
  Three patients had excellent results, while 5 patients had good results and 2 had moderate results; none of the cases had poor results. No major adverse events were observed. Small keloids can be treated with non-surgical therapy or radical excision, although followed by an adjuvant therapy. Radiotherapy seems to be a better adjuvant approach. The mechanism for the radiotherapeutic prevention of keloids is still poorly understood. It may act by controlling collagen synthesis through the elimination of abnormally-activated fibroblasts.
  
  
  CONCLUSIONS
  From our results, postoperative electron radiotherapy is an effective and well-tolerated treatment to prevent keloid recurrence, especially in patients with bulky keloids or recurrent disease.
authors.affiliation: Operative Unit of Plastic and Reconstructive Surgery, "Regina Elena" National Cancer Institute - IFO, Rome, Italy - zoccali.giovanni@virgilio.it.
authors.forename: Marcello
authors.initials: M
authors.lastname: Pozzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zoccali
authors.forename: Maria C
authors.initials: MC
authors.lastname: Drago
authors.forename: Maria A
authors.initials: MA
authors.lastname: Mirri
authors.forename: Maurizio
authors.initials: M
authors.lastname: Costantini
authors.forename: Roy
authors.initials: R
authors.lastname: DE Vita
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007627:Keloid / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult