The Role of Radiation Therapy in Pediatric Keloid Management: Case Series and Systematic Review

Radiation therapy following surgical excision is an effective strategy for recurrent keloids in adults. However, concerns about radiation-induced malignancy in children have limited its use and study in younger populations. This study aimed to assess clinical outcomes of postoperative radiation for recurrent pediatric keloids through a pooled literature analysis and review of our institutional experience.

A retrospective review was conducted of all pediatric patients treated at the Children's Hospital of Philadelphia from 2000 to 2024 who underwent reexcision followed by postoperative radiation for recurrent keloids. Recurrence was defined as clinical evidence of regrowth beyond scar borders. A systematic review was also performed in March 2025 in accordance with PRISMA guidelines, using terms related to "keloid," "radiation," and "pediatric." Studies' eligibility criteria were assessed for quality using the Oxford Levels of Evidence.

Five published studies and 1 institutional series comprising 60 patients and 85 keloids were included (mean age, 14.4 ± 3.5 years). Most lesions were on the earlobes (38.3%). Brachytherapy (53.3%) and external beam radiation (46.7%), most commonly at 12 Gy in 3 fractions, were the primary modalities, typically delivered within 24 hours postoperatively. Adjunctive treatments included corticosteroids (21.7%) and compression therapy (20.0%). Overall recurrence was 22.4%. Hyperpigmentation (53.3%) and transient pruritus (15.0%) were common side effects. No cases of secondary malignancy or growth disturbance were observed (mean follow-up, 32.3 ± 24.0 months).

Postoperative radiation following reexcision may serve as an effective treatment for recurrent pediatric keloids. Further long-term prospective studies are warranted to evaluate durability and oncologic safety in the long term.