Radiation Therapy for Keloids: Safety Concerns and Treatment Insights

Radiation therapy for keloids?

Hello, doctor.
My family member has keloids on the chest and back.
If surgery is performed for removal, it must be accompanied by radiation therapy to reduce recurrence.
I have a few questions:
Q1: Since my family member is planning to get married and have children soon, I am concerned about the potential impact of radiation therapy on future offspring, despite many reports stating that low-dose radiation is used for keloids.
Will this really affect sperm?
Q2: If the chest and back are treated separately, will the accumulated radiation dose be too high? How long should the interval be between treatments? I've heard that the effects of radiation therapy can last at least two years.
Q3: It is generally understood that radiation is used in cancer treatment.
Will radiation therapy on the skin of a healthy person cause damage to normal cells and organs? I apologize for the many questions, but I am really conflicted about whether to proceed with treatment.

Yang, 50~59 year old female. Ask Date: 2023/11/26

Dr. Wang Yifen reply Radiology

Hello, regarding the radiation therapy for keloids, Dr.
Song Shiyu from the Department of Radiation Oncology at Changhua Hospital provided the following responses:
1.
After external beam radiation therapy, there will be no residual radiation in the patient's body, and they will not carry any radiation home, which means it will not affect family members.
There is no impact on dining with family or holding children.
Male patients receiving pelvic radiation therapy may experience a temporary decrease in sperm count and quality, which could affect fertility.
However, if the keloid treatment area is on the chest, the dose received by the testes is extremely low due to the distance.
2.
The radiation dose for keloid treatment is approximately 8-20 Gray (Gy), commonly using electron beams, which penetrate only a few centimeters beneath the skin surface.
Therefore, when treating keloids on the chest and back, the effects are not directly additive.
Currently, there are no clinical guidelines recommending a specific interval between treatments, and simultaneous irradiation is generally acceptable.
However, if surgery is performed on both areas, wound care may become more complicated.
3.
As mentioned earlier, keloid treatment typically employs electron beams (which have shallower penetration) and lower doses (8-20 Gy).
In contrast, cancer radiation therapy often uses photon beams (which can easily penetrate the body) and higher doses (30-80 Gy).
Due to the lower dose and shallow depth, keloid treatment generally does not produce the common short-term side effects associated with cancer radiation therapy (such as dermatitis, mucositis, or radiation pneumonitis).
However, the potential carcinogenic risk from exposure should be considered; for instance, radiation to the chest for keloids may slightly increase the risk of breast cancer in women.
The probability of radiation-induced cancer typically requires decades of follow-up studies to be observed.
Therefore, conservative treatment (such as steroid injections) is often recommended for younger patients with keloids.
If the keloid significantly impacts quality of life (causing pain, itching, or tightness), a combination of surgery and radiation therapy is a highly effective treatment option and is widely used for patients with keloids unresponsive to conservative treatment.
If your family has questions about radiation therapy for keloids, it is advisable to consult a radiation oncologist for evaluation and treatment.

Please refer to the above information, and I wish you peace and health.

Reply Date: 2023/11/26

More Info

Radiation therapy is a common treatment modality for various conditions, including keloids, which are raised scars that can occur after injury or surgery. While radiation therapy can be effective in reducing the recurrence of keloids post-surgery, it is understandable to have concerns about its safety, especially when considering future family planning. Let’s address your questions one by one.

Q1: Will radiation therapy affect sperm and future children?
Radiation therapy, particularly when used at low doses for keloids, is generally localized and does not typically affect the entire body. However, if the radiation is directed near the reproductive organs, there could be a risk of affecting sperm production. The extent of this risk largely depends on the dose and the area being treated. In most cases, low-dose radiation used for keloids is unlikely to have a significant impact on fertility or the health of future children. Studies suggest that sperm can recover after exposure to low doses of radiation, but it is advisable to discuss this with your healthcare provider, who may recommend sperm banking if there are concerns about fertility.

Q2: Is there a risk of excessive radiation exposure if treated in separate sessions?
When treating different areas of the body, such as the chest and back, the cumulative radiation dose is a valid concern. Each treatment session contributes to the total dose, and while low-dose radiation is generally considered safe, it is essential to monitor the total exposure. The effects of radiation can persist, and while it is true that the biological effects of radiation can last for years, the risk of significant harm from low-dose radiation is minimal. It is crucial to follow your healthcare provider's recommendations regarding treatment intervals and to ensure that the total dose remains within safe limits. Typically, healthcare providers will space out treatments to minimize cumulative exposure and allow for recovery.

Q3: Does radiation therapy harm normal cells and organs?
Radiation therapy does have the potential to affect normal cells, but the goal of treatment is to minimize this risk while effectively targeting the keloid tissue. The skin and surrounding tissues can experience some side effects, such as redness, irritation, or temporary changes in pigmentation, but these are usually mild and resolve over time. The key is that radiation therapy for keloids is delivered in a controlled manner, often using techniques that focus on the keloid while sparing surrounding healthy tissue as much as possible.
In general, the benefits of using radiation therapy to prevent keloid recurrence often outweigh the risks, especially when the treatment is carefully planned and monitored. It is essential to have an open discussion with your healthcare provider about your concerns, the specifics of the treatment plan, and any potential risks involved. They can provide personalized advice based on your family history, health status, and the specifics of the keloids being treated.

In conclusion, while there are valid concerns regarding radiation therapy, especially in the context of family planning, the risks associated with low-dose radiation for keloids are generally manageable. It is crucial to weigh the benefits of reducing keloid recurrence against the potential risks and to make informed decisions in consultation with your healthcare team.

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