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Optimizing Radiotherapy for Keloids: A Meta-Analysis Systematic Review Comparing Recurrence Rates Between Different
Peter Mankowski1, Jonathan Kanevsky, Jared Tomlinson
1From the *Division of Plastic and Reconstructive Surgery, and †St. Mary's Research Centre, University of McGill Health Centre, Montreal, Quebec, Canada.
Annals of Plastic Surgery
|February 9, 2017
Summary
Postoperative radiotherapy is an effective keloid management strategy. Brachytherapy, a type of radiation therapy, demonstrated the lowest recurrence rates compared to other radiation modalities for keloid treatment.
Area of Science:
- Dermatology
- Radiation Oncology
- Surgical Outcomes
Background:
- Keloids have a high recurrence rate after surgical excision.
- Multiple treatment adjuncts are used to improve cosmetic outcomes, but no single standardized modality exists.
- Radiation-based treatments are explored for keloid management.
Purpose of the Study:
- To review radiation-based treatments (brachytherapy, electron beam, X-ray) for keloid management.
- To compare the outcomes of different radiation modalities in keloid treatment.
Main Methods:
- Comprehensive literature review from 1942 to October 2014.
- Databases searched include PubMed, MEDLINE, Biosis, Embase, Google Scholar, and Cochrane.
- Articles were analyzed for case numbers, patient demographics, keloid location, follow-up, radiation modality, dose, recurrence, and complications.
Main Results:
- 72 studies including 9048 keloids were reviewed.
- Postoperative radiotherapy showed lower recurrence (22%) than radiotherapy alone (37%).
- Postoperative brachytherapy had the lowest recurrence rate (15%) compared to X-ray and electron beam (23% each).
- Chest keloids exhibited the highest recurrence rates.
- Skin pigmentation changes were the most frequent side effect.
Conclusions:
- Postoperative radiotherapy is an effective management strategy for keloids.
- Brachytherapy emerged as the most effective radiation modality for keloid treatment.
- Further standardization of treatment modalities is needed.
