External beam irradiation in keloid management: two case reports and review of literature

Keloid is a benign fibroproliferative skin disorder. Surgery has a high recurrence rate as the treatment of choice to instantly eliminate the lesion, so adjuvant radiotherapy may be useful. This article aims to discuss case reports and present a systematic review of external beam radiation therapy (EBRT) as an adjuvant in postoperative keloid management.

Case reports were obtained from patients in our institution. Informed consent was obtained for each patient. Articles found on literature search from Pubmed and Scopus were processed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Centre of Evidence-Based Medicine University of Oxford guidelines. The risk of bias was rated using the Cochrane risk of bias tool.

We reported the cases of two Asian women aged 18 and 23 years old with a history of injury to the earlobe before keloid formation. Postoperative radiotherapy was administered within 7 hours, with an 8-months follow-up showing no recurrence and grade 1 toxicity. Five articles appraised in this review suggested a lower recurrence rate for postoperative radiotherapy compared to steroid injection and conventional surgery (11.5 vs. 26.67 vs. 33%). Brachytherapy had a lower recurrence rate than external radiation but was limited by the need for a special applicator. The side effects of all treatment modalities in this study were well-tolerated.

Postoperative EBRT is a promising modality to minimize the risk of recurrence with low toxicity for keloid lesions. More randomized control trials are needed to better understand the role of EBRT in keloid management.