Comparison of Single-Fraction Versus Fractionated Adjuvant Electron Beam Radiotherapy Following Excision of Auricular...

Postoperative radiotherapy is effective for reducing recurrence of auricular keloids, yet the optimal dose fractionation remains debated. This retrospective cohort study compared single-fraction 10 Gy versus fractionated 10 Gy (2×5 Gy) electron beam radiotherapy following keloid excision. Seventy-seven patients were enrolled, with 37 receiving a single 10 Gy fraction (group A) and 40 receiving 5 Gy×2 fractions (group B). All patients underwent complete surgical excision and initiated radiotherapy within 24 hours postoperatively. The primary endpoint was local recurrence; secondary endpoints included scar aesthetic quality assessed using the Patient and Observer Scar Assessment Scale (POSAS 2.0) and radiotherapy-related complications. With a median follow-up of 19.0 months in both groups, the recurrence rate was 2.7% in group A and 7.5% in group B (P=0.616). The total observer POSAS score was significantly lower in group A (14.3±3.7 versus 16.5±4.3, P=0.019), indicating superior objective scar quality, while patient-reported scores showed no significant difference. Both regimens were well-tolerated, with no severe adverse events and comparable rates of acute dermatitis, pigmentary changes, and telangiectasia. In conclusion, single-fraction 10 Gy electron beam radiotherapy achieves comparable local control to fractionated 10 Gy and yields superior objective aesthetic outcomes. Combined with its convenience and health economic advantages, single-fraction 10 Gy represents a safe and preferred clinical option for auricular keloids.