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Optimizing Radiotherapy for Keloids: A Meta-Analysis Systematic Review Comparing Recurrence Rates Between Different Radiation Modalities

Mankowski, Peter MD, MSc; Kanevsky, Jonathan MD, CM; Tomlinson, Jared MD; Dyachenko, Alina MSc; Luc, Mario MD

doi: 10.1097/SAP.0000000000000989
Burn Surgery and Research

Background The high recurrence rate of keloids has lead to the use of multiple treatment adjuncts to improve cosmetic outcomes after surgery. To date, there has been no single, standardized modality agreed upon to produce the best results. The purpose of this study was to review the radiation-based treatments (brachytherapy, electron beam and X-ray) used for keloid management and compare their outcomes.

Methods A literature review was performed from 1942 to October 2014 using the databases: PubMed database of the National Center of Biotechnology Information, MEDLINE, Biosis, Embase, Google scholar, and Cochrane database. Articles were reviewed for case numbers, patient demographics, keloid location, follow up, radiation modality, dose, keloid recurrence, and complications.

Results A total of 72 studies met the inclusion criteria representing 9048 keloids. These studies were categorized by treatment: brachytherapy, electron, or X-ray. Meta-analysis demonstrated that radiotherapy after surgery had less recurrence when compared to radiotherapy alone (22% and 37%, respectively, P = 0.005). Comparison between modalities revealed that postoperative brachytherapy yielded the lowest recurrence rate (15%) compared with X-ray and electron beam (23% and 23%, respectively; P =0.04, P = 0.1). Subgroup analysis by location demonstrated chest keloids have the highest recurrence rate. The most commonly reported side effect of radiotherapy was changes in skin pigmentation.

Conclusions The results of this study reinforce postoperative radiotherapy as effective management for keloids. Specifically, brachytherapy was the most effective of the currently used radiation modalities.

Supplemental digital content is available in the text.

From the *Division of Plastic and Reconstructive Surgery, and †St. Mary’s Research Centre, University of McGill Health Centre, Montreal, Quebec, Canada.

Received April 5, 2016, and accepted for publication, after revision December 12, 2016.

Conflict of interest and sources of funding: none declared.

Presentation at a meeting: Organization: Association of plastic and aesthetic surgery of Quebec. Place: Mont Tremblant, Quebec, Canada Date: February 28, 2015.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Reprints: Peter Mankowski, MD, MSc, 401-1290W 11 Avenue, Vancouver, British Columbia, Canada. E-mail:

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