Radiotherapy in Keloid Treatment: An Evidence-Based Approach

Keloid scars are a persistent and often challenging condition characterised by raised, overgrown scar tissue that extends beyond the original wound. These scars can cause physical discomfort, emotional distress, and recurrence, even after initial treatments. For patients seeking advanced care, radiotherapy has long been recognised as an effective adjuvant treatment, particularly when combined with other therapies.

This blog explores how radiotherapy fits into keloid scar management, its benefits, risks, and why a multimodal approach is often the gold standard for stubborn keloids.

Radiotherapy offers distinct advantages in managing keloid scars, integrated into broader treatment plans.

Effective at Reducing Recurrence

Keloid scars notoriously recur after treatment, with rates as high as 50–100% following surgical excision alone. When used as an adjuvant therapy, radiotherapy can reduce recurrence rates to approximately 10–20% by suppressing fibroblast activity and excessive collagen production. This makes it one of the most reliable evidence-based strategies for long-term keloid control.

Precision in Targeting Scar Tissue

Modern radiotherapy techniques, such as external beam radiation therapy (EBRT) and allow for precise targeting of scar tissue, minimising damage to surrounding healthy skin.

Suitable for Resistant Keloids

For large or recurrent keloids that have not responded to other therapies, radiotherapy provides a valuable adjuvant option—particularly when combined with surgical removal.

While radiotherapy is well-established and effective, its use requires careful patient selection.

Potential Side Effects:

Early side effects:

• Pigmentation changes (temporary or permanent, more common in darker skin tones)
• Redness and inflammation usually resolving within days
• Mild fatigue resolving within days

Late side effcts:

• Hair loss (only at the site treated)
• Very rarely impact on wound healing
• Extremely rarely there may be along-term risk of malignancy

Radiotherapy for keloids is most effective when delivered within a carefully structured protocol, making specialised evaluation essential. Key considerations include:

Patient factors:

• such as age, general health, and keloid location

Treatment factors:

• particularly the coordination of radiotherapy in relation to surgical excision- can be done before or directly after surgery

• dose and follow up: determined and monitored by a radiation oncologist to maximise safety and efficacy

At our Sydney scar clinic, radiotherapy is provided through a multidisciplinary team, with our radiation oncologist collaborating closely to ensure treatment is individualised, evidence-based, and aligned with international protocols.

Radiotherapy is rarely used alone; it is most effective as part of a multimodal plan.

• Surgical excision + radiotherapy: excision reduces bulk, radiotherapy suppresses regrowth.

• Intralesional Corticosteroids: help control inflammation and vascularity.

• Laser-assisted drug delivery (LADD): enhances penetration of agents like corticosteroids or 5-FU into keloid tissue.

• Compression therapy & silicone: stabilise scar tissue and reduce tension.

This integrated approach is strongly supported by international guidelines.

Radiotherapy is not a new treatment for keloids, but when used judiciously as an adjuvant therapy, it is one of the most effective ways to reduce recurrence and improve long-term outcomes. Its value lies in being part of a specialist-led, multimodal strategy, tailored to each patient’s scar pattern and risk profile.

If you’re struggling with keloid scars, a consultation at Scarless - The Clinic can help determine whether radiotherapy—together with surgery, laser therapy, and other evidence-based treatments—is right for you.