Radiotherapy for Keloid scars

Although you may have heard about radiotherapy from friends, relatives and/or other patients, it is important to remember that their experience may not be the same as yours. In all cases, a doctor will explain your radiotherapy treatment to you and answer any questions you may have.

We are here to help so if you would like further information or have any particular concerns, please do not hesitate to ask a radiographer or a member of the radiotherapy review specialist team.

In most cases, a friend, relative or carer may accompany you to your appointments. This will depend on any infection control guidelines currently in place. Please ask your doctor or a member of the radiotherapy team if this is possible.

What is radiotherapy?

Radiotherapy treatment for keloid scars uses carefully measured doses of superficial or low dose x-rays to target the site of the scar. Treatment is given using a superficial x-ray machine, sometimes called the skin unit or superficial unit.

Using external beam radiotherapy to treat keloid scars

Radiotherapy treatment for keloid scars is given following surgical removal of the scar. This has been shown to be highly effective in reducing keloid recurrence compared to surgery alone. After your surgery, you will need two radiotherapy treatments; one within 48 hours of your surgery and one a week later.

Planning your radiotherapy treatment

Your first visit to the radiotherapy department will be for a markup to plan your radiotherapy treatment. During this appointment the area(s) for treatment will be confirmed and a marker pen used to clearly identify the area by drawing on your skin.

An outline and photographs of the area being treated will be taken. The pen marks are removed at the end of the mark-up session.

If the area for treatment is irregular, it may be necessary to have an individual lead template made to protect the tissue we do not wish to treat. This will be explained to you fully if it is applicable to you. This mark-up process may take up to one hour, depending on how many areas are being marked up.

The radiographers will then do some calculations to work out the length of time your treatment will take. This may take a few hours to complete, therefore you may wish to go away and come back at a later time, which we will give you.

Your radiotherapy treatment

You will have your first treatment on the day of your first visit, about two to three hours after the mark-up session. Your second visit will be a week later and will be much shorter, taking no longer than 30 minutes.

The radiographers giving the treatment will position the machine so it touches the skin around the area to be treated, as marked out by your doctor. The actual treatment only takes a few minutes during which you will be left in the room alone.

The radiographers will be observing and, if necessary, will be able to talk to you from the next room where they will be able to always hear you. There is no sensation from the treatment and it is painless.

Appointment details

A member of the radiotherapy team will contact you with the date and time of your appointment once we know the date of your surgery.

It is also helpful to contact us when you are given the date of surgery by the plastic surgeons so we can confirm the date and time of your radiotherapy treatment.

Where do I go for treatment?

The skin unit is in the radiotherapy department. The department is located on the ground floor of the Royal Free Hospital. It can be accessed via a separate entrance to the side of the main hospital entrance. You can also follow signs to the heart attack centre.

Short-term side effects of radiotherapy treatment

Some side effects are short term or known as acute side effects. These will typically worsen gradually for two to three weeks after you finish your treatment and take a further two to three weeks to reduce. This may not be the case during your treatment but if you are concerned about any side affects you are experiencing, speak to a member of your medical team.

Examples of possible short term side effects from radiotherapy for keloid scar can include the following:

Skin reaction

Your skin may be sore after treatment. This will gradually get better over the next six weeks following treatment.

Advice on skin care and any dressings will be given to you following your surgery by the plastic surgery team. It is better to keep the treated area out of strong winds and sunshine. They can irritate the skin and make the reaction worse. You should also try to avoid clothes that will rub against the treated area.

Long term side effects

These usually start to occur more than three months after finishing your course of treatment, but sometimes much later.

Increased skin pigmentation

In the long term, your skin may become discoloured (pigmented) over the treated area, i.e., become lighter or darker than before.

The treated area will be more sensitive to the sun and a sunblock of SPF 50 cream should be used. Please limit the amount of time you are exposed to the sun.

Cancer risk

Radiotherapy carries a very small risk of long-term development of cancer. Although this is a serious possible risk of your radiotherapy, it is important to bear in mind that the effect is very rare. If it does happen it is likely to be many years after treatment.

Follow-up

Your plastic surgery team will arrange for any stitches in your scar to be removed. If there is any sign of infection, such as discharge from the wound, or you have any other concerns about your scar, please contact the plastic surgery team or your GP.

You will be seen for a follow-up appointment by a member of the plastic surgery team – they will send you these appointment details.

Travelling to and parking at the Royal Free Hospital

As parking at the Royal Free Hospital and the surrounding area are limited, we strongly encourage that you travel to your appointment using public transport if possible.

Parking at the Royal Free Hospital is free for patients having radiotherapy treatment, parking in allocated spaces only. These are available in front of the main hospital entrance on Pond Street.

You will need to display a radiotherapy parking permit in your car, which we will issue you during your first visit.

Access more information on car parking at Royal Free Hospital.

Please provide the radiotherapy receptionist with your car registration number on arrival to avoid being issued a parking fine.

Free parking is only available for patients attending their treatment appointments and is not available for outpatient clinic appointments.

Will I be eligible for hospital transport?

Patient transport is a service provided for patients who are unable to attend hospital appointments by public transport or any other means (including private minicab) due to their medical condition.

Patients or a relative must book their own transport to and from the hospital if they are travelling from home. Transport must be booked at least 48 hours before your appointment.

More information on how to book non-emergency patient transport.