Additional Invasive Techniques in Scar Management

Radiation therapy is a last resort option for recurring and therapy-resistant keloid scars. It represents a significant burden to the patient and both financially and logistically to the healthcare system. Radiation therapy yields excellent results, both functionally and aesthetically and in low recurrence rates. An efficacious treatment protocol consists of excision of the entire keloid, followed by rapid administration of the first radiation dose. The most commonly used techniques are external radiation, low-dose-rate brachytherapy, and high-dose-rate brachytherapy. Brachytherapy is associated with fewer side effects and a lower recurrence rate in comparison with external radiation. The use of high-dose-rate brachytherapy is more convenient because it allows an outpatient setting and prevents unnecessary radiation damage to the surrounding tissue. Although more research is needed, a biological effective dose (BED) of 20–30 Gy, for example, 2 × 6 Gy, seems sufficient for most cases. The most commonly seen complications are erythema, temporary and permanent pigmentation disturbances, and telangiectasia. Although it is necessary to mention the risk of inducing secondary malignancy in the treated area, only a few cases have been described, out of which none were caused by brachytherapy.