Postoperative radiotherapy in the management of keloids

Abstract

BackgroundThe high recurrence rate following keloid resection has generated interest in adjuvant treatments for this disease.ObjectiveThis study assesses keloid recurrence when treated with surgery and adjuvant radiotherapy.MethodsRetrospective analysis of resected keloids in patients referred to a Chilean radiation oncology centre between 2006 and 2013. Local recurrence was defined as new tissue growth on the surgical scar margin.ResultsAround103 keloids were analysed in 63 patients treated with 15 Gy in three fraction radiotherapy which was initiated on the same day as the surgery (75% of cases). The median keloid diameter was 6 cm; the most common site was thoracic (22%); the most common cause was prior surgery (35%); 37% caused symptoms, and several (47%) had received prior treatment with corticosteroids (32%), or surgery (30%). The median follow-up was three years, and 94% of recurrences occurred during the first year following treatment. Uni and multivariate analyses showed that an absence of symptoms was a protective factor for recurrence (OR: 0.24), while the time interval from onset to treatment with surgery plus radiotherapy >4.2 years was a risk factor (OR: 2.23). The first year recurrence rate was 32% and stabilised at 32% by the second year with no recurrences after 15 months.ConclusionsThe combination of surgery and radiotherapy proved to be a good therapeutic alternative in the management of keloids. Our results are similar to those described in the literature for a dose of 15 Gy. Given these results, our centre will implement a new dose escalation protocol to improve future outcomes.

Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

“…The duration of the follow-up for 23 subjects was <32 weeks. Previous studies have found that 50-94% of pathological scars recurred after 1 year of treatment (81,82). Nonetheless, long-term follow-up can be difficult because most patients lose interest in follow-up after achieving satisfactory treatment results.…”

Assessing keloid recurrence following surgical excision and radiation

“…In several trials with electron beam radiation therapy, the definition of keloid recurrence was not specified [ 23–26 ]. One study defined recurrence as new tissue growth on the surgical scar margin [ 27 ], while another study based treatment success on each patient’s self-assessment at 18 months post-treatment as follows: Very satisfied, no recurrence, no symptoms; Satisfied, ≤50% recurrence without symptoms; and Unsatisfied, >50% recurrence with symptoms [ 28 ] ( Table 1 ). One study classified response to treatment into four groups: Good, no visible scar or small scar in the plane of the skin, no complaints and no recurrence during follow-up; Improved, no itching or other complaints, visible scar partly elevated by no more than 1 mm above the plane of the skin, slight dehiscence and no recurrence during follow-up; Invalid, scar remained and was accompanied by swelling and itching symptoms after treatment and within 3 months; and Relapse, treatment was effective for 3 months but scar became elevated above the plane of the skin, or scar dehiscence and itching and erythema symptoms appeared again after 3 months.…”