Efficacy of radiation therapy following keloidectomy on the recurrence

Background: The treatment of keloids is unsatisfactory and even a challenge to many dermatologists or dermatosurgeons. Simple excision of a keloid alone is associated with a high recurrence rate. Thus, surgical treatment should be combined with various adjuvant therapies. Objective: The aim of this study was to evaluate the efficacy of postoperative radiation therapy on the recurrence of keloids. Methods: Between March 2007 and May 2012, 24 patients with keloids (n=56) in various anatomical sites were treated with our protocol consisting of total or subtotal keloidectomy followed by immediate irradiation of 12 ∼ 18 Gy in 3 fractions over 3 days with pře- and postoperative intralesional steroid injection as an adjuvant therapy. After a year to a year and a half, treatment was terminated at that point. Results: When treated keloids were classified according to the degree of flattening, the outcomes were excellent in 48.2% (27/56) of the patients, good in 32.1% (18/56), fair in 14.3% (8/56), and poor in 5.3% (3/56). This treatment protocol showed almost excellent outcomes in earlobe, earhelix, retroauricular region and abdomen. Although the sites with high stretch tension such as chest and shoulder showed above good outcomes 72% 18/25), they also showed three poor results. The most common complication was postinflammatory hyperpigmentation while the most serious one was full-thickness skin necrosis, which was recovered by skin graft later. Conclusion: Radiation therapy is an effective and safe therapy for the prevention of recurrence of keloids following keloidectomy.