Table 6 Radiotherapy

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