A Revolutionary New Combined Treatment for Aggressive Keloid Tumours Without Need for Surgery: A Patient Series
John Glees1 MD, FRCR, DMRT, Patricia Yap2 BSc, MBBS, Dip Derm and Henry Weatherburn1 PhD
BACKGROUND
When the treatment for keloids is undertaken using a monotherapy, e.g. surgery alone, or radiotherapy alone, significant recurrence rates have been reported and, consequently, keloid treatment procedures normally employ a combination of treatments, e.g. surgery immediately followed by radiotherapy, with much lower recurrence rates reported. However for patients who have aggressive (and frequently recurrent) keloids, particularly at: individual difficult to excise anatomical sites; or at multiple sites, this approach may not be practicable, especially in patients who have had previous excisions and are unwilling to undergo further surgery, or for patients who simply wish to avoid surgery.
In such cases, a previously reported practicable non-surgical approach to treatment is the topical application of a low molecular weight (LMW) corticosteroid cream (Keloflat), which achieves penetration through the basal layers of the skin: this has shown promising results, some in combination with the use of steroid injections.2 &
3 A subsequent case study has also reported successful use of this cream as an adjunct to surgery for a recurrent keloid.4 Separately, for recurrent keloids (previously treated by surgery and radiotherapy with a 5 year recurrence rate of 14.7%5), a subsequent course of fractionated superficial X-ray radiotherapy (SXRT) has shown low recurrence rates for such keloids.6 (Updated results to this latter study can now be reported: these show that 3/23 [13%] of such patients exhibited a recurrence some 5 to 6 years post completion of treatment).
Against this background, the desirability and the practicality of a dual non-surgical
approach to keloid treatment, with the concurrent use of the topical cream and fractionated SXRT, was considered by the authors reporting these studies. A protocol
was then developed which integrated application of the topical cream with a fractionated course of SXRT over a period of up to 1 year.
CONCLUSION
To date progress to successful treatment outcomes can be reported for patients who have been treated by the “Keloflat and Fractionated SXRT” protocol, who would
otherwise have had surgery, possibly involving skin grafts, followed by radiotherapy. This mode of treatment looks very promising and could potentially revolutionise keloid treatment by offering a viable non-surgical alternative to current treatment with surgery followed by radiotherapy, as well as being a viable alternative to other treatment methods. Use of this approach to treatment is ongoing and future reporting of audit results of patient outcomes is planned.
The methods, results, figures and the downloadable PDF are available to subscribers.
