Table 6.
Radiotherapy
| First author, year | Study design | Treatment | Duration | N | Outcome(s) | Follow-up time | Adverse events | Comments |
|---|---|---|---|---|---|---|---|---|
| Aluko-Olokun, 2014 [88] | RCT | IL TAC 10 mg/cm vs excision with 16 gray (Gy) RT (electron) | Q2 weeks for 6 months vs 4 Gy daily for 4 days starting immediately post-op | 107 | Flattening in 81% vs 58% remained flat (p < 0.01) | 18 months | Hypopigmentation, ulceration, hyperpigmentation, atrophy, telangiectasia vs pruritus, tenderness, hyperpigmentation | Pinna lesions were 80% of lesions not cured by IL TAC |
| Dunst, 2013 [89] | P | Excision with brachytherapy of 18 Gy in 3 fractions within first day | All sessions within 36 h of excision | 12 (15 keloids) | No recurrence, symptomatic relief | Median 18 months | Hyperpigmentation, hypopigmentation | |
| Emad, 2010 [90] | P | Excision with 12 Gy radiation (x-ray) vs IL TAC with cryotherapy | 4 Gy weekly for 3 weeks starting within 48 hrs vs q20 days until flattening or no response | 26 (76 keloids) | Complete remission 70.4% vs 68.8%; partial remission 11.4% vs 3.1%; failure 18.2% vs 28.2%; complete or partial patient satisfaction 100% vs 88.9% | Mean 19 months | 25% vs 59.4%: hyperpigmentation, hypopigmentation, telangiectasia, infectious/wound dehiscence vs hypopigmentation, ulceration/necrosis, telangiectasia | |
| Gupta, 2012 [91] | P | Re-188 skin bandage | 2 days | 6 | 1 patient with resolution, 5 patients decrease in size and flattening | 3 months | No toxicity | |
| Gupta, 2013 [92] | RCT | P-32 versus Re-188 | 16 (42 keloids) | 77% vs 59% with > 50% flattening (p = 0.664) | Median 6 months | Radiation dermatitis, no difference between groups | ||
| Gupta, 2017 [93] | P | Re-188 | 3 sessions qod daily | 11 (33 keloids) | No recurrence, 67% had > 50% decrease in size | 3 years | Radiation dermatitis | |
| Hafkamp, 2017 [94] | P | Excision with 13 Gy from implanted catheter within 2-h post-op | 1 day | 24 (29 keloids) | Recurrence rate of 24.1%, POSAS mean of 24.3 | > 1 year, median 53 mo | Infection, chronic wound, dehiscence, hyperpigmentation | Only 24 of the 61 patients invited participated |
| Jiang, 2016 [95] | P | Excision with 18 Gy in 3 fractions within 6-h post-op | 3 doses of 6 Gy over 36 h | 24 (32 keloids) | Recurrence rate of 6% | Median 29.4 mo | Hypopigmentation, hyperpigmentation, delayed wound healing | |
| Jiang, 2018 [96] | P | Excision with 18 Gy in 3 fractions within 6-h post-op | 3 doses of 6 Gy over 36 h | 29 (37 keloids) | Recurrence rate of 8.1%, hypertrophied scars 5.4% | Median 5 years | Delayed wound healing, hyperpigmentation, hypopigmentation, telangiectasia | |
| Jones, 2019 [97] | P | Excision with up to 18 gy starting 24-h post-op | Up to 18 Gy divided over 4 days | 48 | 19% recurrence | 12 months | None reported | |
| Khalid, 2018 [110] | RCT | Excision with IL TAC/5-FU vs excision with 10 Gy total started within 24-h post-op | Q1 month until resolution vs two consecutive days (5 Gy each) | 60 | 73.33% vs 43.33% had no recurrence after 6 months (p = 0.01) | 6 months | Skin epidermolysis, wound dehiscence versus skin redness | Keloids on the ears |
| Kim, 2012 [98] | P | 12 to 15 Gy divided into 3 fractions started within 24 h of excision | 26 | 77% complete response | 19–36 months | hyperpigmentation | Cesarian section keloids | |
| Lee, 2015 [99] | P | Excision then 12–18 total Gy started within 24 vs 24–72 vs > 72-h post-op | 3–4 Gy every other day | 30 (37 keloids) | 7 recurred, 1 treated within 24 h and 6 treated > 72 h (p < 0.0001) | 9–51 months | Erythema, hyperpigmentation | |
| Li, 2014 [100] | RCT | Excision, split thickness graft, 900-cGy radiotherapy vs precut, radiotherapy, excision with split thickness graft, post-RT | RT 10–14 days post-op and repeat 7 days vs RT prior to full excision with repeat 10–14 days post-op | 53 | 55.2% vs 16.7% recurrence; 48.3% vs 8.3% dissatisfied with aesthetic results | 12 months | Not stated | Chest wall keloids |
| Li, 2017 [101] | P | Precut, 900-cGy radiotherapy, excision with graft and repeat 900-cGy radiotherapy if graft survived | 86 | 12.79% recurrence | 24 months | Pruritus | Chest wall keloids | |
| Liu, 2018 [102] | p | Keloid scar dissected from keloidal skin used as flap, post-op radiotherapy, hypobaric O2, silicone sheet, and pressure bandage | 900-cGy radiotherapy at days 1 and 7 post-op, HBO at day 2 and cont daily until suture removal, silicone and pressure for 6–12 months | 45 | 11.1% recurrence; 84.4% patients satisfied | Mean 18 months | Dyschromia, telangiectasia | Facial keloids |
| Masoodi, 2014 [103] | P | Excision, 40 mg/mL IL TAC, split thickness graft, one dose 10-Gy radiotherapy within 20-h post-op | 12 weeks of silicone sheeting started 3 weeks post-op, plastic clip if VSS > 5 after 12 weeks | 24 | 12.5% recurrence rate, 8.3% with VSS of > 10, mean VSS post-op 4.92 vs pre-op 10.37 | >12 months | Hematoma, infection, skin graft loss, regrafting, dyschromia, vascularity, pruritus | Auricular keloids |
| Mohammadi, 2013 [104] | P | Excision, RT within 24-h post-op | 3 Gy daily for 5 days | 17 (26 keloids) | VSS pre-op 11.35 vs post-op 3.88 (p < 0.005), no recurrence after 16 months | > 11 months | No complications | |
| Song, 2014 [105] | P | Excision then 10-Gy RT within 72 hrs, pressure, tranilast | Pressure and tranilast for > 3 months | 12 (16 keloids) | No recurrence | Mean 20 months | Hyperpigmentation | |
| Van Leeuwen, 2014 [106] | P | Excision, 12-Gy RT | 6-Gy RT within 4 hrs and 6 Gy within 24 hrs | 43 (67 keloids) | 3.1% recurrence; POSAS physician 16.71 and patient 19.69 mean post-op (range 0 to 60 worst) | Mean 33.6 months | Post-op infection, hypopigmentation, hyperpigmentation, | |
| Vera, 2019 [107] | P | Excision with brachytherapy catheter 12 Gy in 4 fractions started within 90 min | Q12 hrs | 51 (61 keloids) | 4.9% recurrence | Median 48 months | Chest | |
| Vila Capel, 2015 [108] | P | Excision, 15 Gy (electron beam) over 5 fractions started within 4-h post-op using aluminum spoiler | 5 fractions of 300 cGy over 1 week | 19 (20 keloids) | 76% no recurrence at end of follow-up | 12–68 months | Itching, pain, hyperpigmentation telangiectasia | |
| Zeng, 2017 [109] | P | Precut, pre-RT w/in 24 hrs, excision with SCIP flat, post-RT at 900 cGy | Pre-RT of 900 cGy twice, second dose post-op day 7 | 12 | Only 1 patient with mild hypertrophic scar | 9–24 months | Hyperpigmentation | Presternal keloids |
P prospective trial, RCT randomized controlled trial, IL intralesional, TAC triamcinolone acetonide, 5-FU5-fluorouracil, qn every n, RT radiotherapy, RF radiofrequency, Gy gray, cGy centigray, hrs hours, mo month