Postoperative Radiation Therapy for Keloids: Safety, Dosing, and Access

William Posten, MD, a dermatologist and Mohs surgeon at Advanced Dermasurgery Associates in Dallas, Texas, and the chief dermatologist of Sensus Healthcare, has practiced surgical dermatology for more than 22 years. In a recent Dermatology Times interview, he reviewed adjuvant radiotherapy following surgical excision of keloids as an approach he considers among the most meaningful advances in his career.¹ He outlined key safety parameters, evolving insurance coverage, and the real-world impact keloids have on patients' lives.

In a previous interview, Posten outlined the clinical rationale for radiation therapy after keloid surgery, its comparative efficacy, and the adherence requirements central to its success.

Safety Parameters and Dosing Considerations

Posten described postoperative radiotherapy for keloids as a safe treatment when delivered according to established state licensure guidelines. He noted a lifetime maximum radiation dose to any given site of approximately 50 grays (5000 centigrays), and said keloid treatment typically involves delivery of around 1800 centigrays. Prior radiotherapy to the same site is a key contraindication to consider, since retreatment is possible once or possibly twice, but repeat dosing at the same location warrants careful evaluation.

"If you follow the licensure and guidelines, it should be considered to be a very safe treatment," Posten said.

Insurance Reimbursement Trends

Historically, insurers have declined to cover keloid treatment, classifying the condition as benign. Posten noted a shift in recent years, with coverage becoming more common. In his clinical experience, roughly half of patients receive reimbursement for surgery combined with radiation, while the other half choose to self-pay.

"More recently, insurance companies have been reimbursing this more and more," Posten said. "In our clinical experience, we find about half the time insurances will reimburse for the surgery plus the radiation, and the other half of the time patients really like this and will self pay to get the treatment done."

Encouraging Broader Clinician Adoption

Posten emphasized the meaningful effect keloids can have on patients' daily lives, noting the condition heavily affects personal, social, and work functioning. He encouraged clinicians who have not yet incorporated this approach to explore whether they can offer it in their own clinics or coordinate with colleagues who do.

"When people have keloids, it heavily affects their personal, social, and work lives, and now we have what I think is a more successful treatment than what was available in the past," Posten said. "I think it would be great if more and more patients had the ability to get this done."

Posten called the current moment in dermatology the most exciting period of his more than 2-decade career, citing the availability of treatments like adjuvant radiation for keloids as a central reason.

Reference

1. Ogawa R, Tosa M, Dohi T, Akaishi S, Kuribayashi S. Surgical excision and postoperative radiotherapy for keloids. Scars Burn Heal. 2019;5:2059513119891113. doi:10.1177/2059513119891113