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

Comparative evidence regarding the effectiveness of adjuvant intralesional triamcinolone versus radiotherapy for auricular keloids remains limited.

To compare adjuvant triamcinolone injection and radiotherapy in preventing recurrence after auricular keloid excision as measured by regrowth of keloid tissue with a minimum follow-up of 6 months.

A systematic review and meta-analysis of PubMed, Embase, Cochrane Library, and Scopus identified studies of auricular keloids treated with excision plus adjuvant radiotherapy or triamcinolone. Non-English articles, case series with fewer than 10 patients, and combined treatments were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale, and pooled recurrence rates were calculated with random-effects models.

Forty-five studies (1,885 lesions) were analyzed. Overall recurrence was comparable (triamcinolone: 12% [95% CI: 0.06-0.18] vs. radiotherapy: 13% [0.06-0.21]; p = 0.83). Triamcinolone recurrence varied by follow-up (≤1 year: 36% [0.24-0.49] vs. >3 years: 20% [0.11-0.33]; p < 0.001), while radiotherapy remained stable. Subgroup analyses showed no significant differences for injection timing or radiation dose.

In this study, the findings suggest that radiotherapy provides durable and superior effectiveness per treatment, whereas triamcinolone requires 4-6 monthly injections and shows progressive loss of long-term effectiveness. Individualized treatment selection that prioritizes long-term stability and treatment frequency is recommended.