Post-excisional radiotherapy for keloid treatment: A systematic review and meta-analysis

Abstract

Background Keloids are aggressive fibroproliferative scars extending beyond wound margins, with high recurrence despite multiple treatment modalities. Combining surgical excision with radiotherapy reduces recurrence, but the optimal timing of radiotherapy remains controversial. Aim To evaluate the effectiveness and optimal timing of post-excisional radiotherapy in preventing keloid recurrence. Methods A systematic review was conducted using Scopus, Web of Science, PubMed, and Cochrane databases from inception to June 2024. Studies were included if they involved keloid patients treated with post-excisional radiotherapy (X-ray, brachytherapy, or electron beam), applied either early (? 24 h post-operation) or late (> 24 h). Studies without data on recurrence or complications were excluded. Outcomes were analysed using rate ratios (RR) with statistical significance set at p < 0.05. Results Of 3076 records identified, 2507 unique studies were screened, and 106 met the inclusion criteria. These studies involved 10,745 keloid lesions. The mean patient age was 35 years, with a nearly equal gender distribution. Recurrence rates were 18% (X-ray), 14% (brachytherapy), and 16% (electron beam). Complication rates were 9%, 18%, and 16%, respectively. No statistically significant difference in recurrence or complications was observed between radiotherapy modalities or between early and late radiotherapy application (p > 0.05 across all subgroups). Conclusion Post-excisional radiotherapy significantly reduces keloid recurrence, but recurrence and complication rates are comparable across X-ray, brachytherapy, and electron beam therapies. Early versus delayed radiotherapy timing does not significantly impact outcomes. These findings highlight that recurrence and complication rates are comparable across radiotherapy modalities and timing windows. Until controlled, standardised trials are available, treatment practice may reasonably reflect physician judgement and local treatment availability. � 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons.