Which Adjuvant Modality Is Superior after Auricular Keloid Excision: Radiotherapy or Triamcinolone? A Systematic...

Area of Science:

• Dermatology
• Plastic Surgery
• Oncology

Background:

• Limited comparative data exists for adjuvant intralesional triamcinolone versus radiotherapy in treating auricular keloids.
• Auricular keloid treatment often involves excision followed by adjuvant therapy to prevent recurrence.

Purpose of the Study:

• To compare the effectiveness of adjuvant triamcinolone injection and radiotherapy in preventing auricular keloid recurrence after surgical excision.
• The study aimed to evaluate keloid regrowth over a minimum 6-month follow-up period.

Main Methods:

• A systematic review and meta-analysis of multiple databases (PubMed, Embase, Cochrane Library, Scopus) was conducted.
• Studies involving auricular keloids treated with excision plus adjuvant radiotherapy or triamcinolone were included, excluding non-English articles and small case series.
• Pooled recurrence rates were calculated using random-effects models, with risk of bias assessed via Cochrane Risk of Bias 2.0 and Newcastle-Ottawa Scale.

Main Results:

• Analysis of 45 studies (1,885 lesions) revealed comparable overall recurrence rates: 12% for triamcinolone versus 13% for radiotherapy (p=0.83).
• Triamcinolone recurrence significantly decreased with longer follow-up (36% at ≤1 year vs. 20% at >3 years; p<0.001), while radiotherapy recurrence remained stable.
• Subgroup analyses did not find significant differences based on injection timing or radiation dose.

Conclusions:

• Radiotherapy demonstrates durable and superior effectiveness per treatment for auricular keloids compared to triamcinolone.
• Triamcinolone requires multiple injections and exhibits a progressive decline in long-term effectiveness.
• Individualized treatment selection prioritizing long-term stability and considering treatment frequency is recommended.