Timing of Adjuvant Radiotherapy After Keloid Excision: A Systematic Review and Meta-Analysis

Background: No consensus exists on the appropriate timing of adjuvant radiotherapy administration after surgical excision of keloids. Objective: This study investigated the appropriate timing of adjuvant radiotherapy. Methods: A systematic review and meta-analysis of randomized controlled trials and observational cohort studies were performed. A pooled estimate of the incidence rate was performed using a random-effect model. Subgroup analyses based on different anatomic regions, biological effective dose, keloid length, and radiotherapy regimen were also conducted. Results: Sixteen observational cohort studies (1908 keloid lesions) met the inclusion criteria. The incidence rate was significantly reduced in the group treated more than 24 h after surgery (3.80%; 95% CI: 1.78% to 8.13%) compared with the group treated within 24 h (37.16%; 95% CI: 20.80% to 66.37%) (P < .0001) with electron beam therapy but was not significantly different between the groups with brachytherapy and X-ray treatment. Limitations: Most of the included studies were single-arm nonrandomized observational studies. Therefore, randomized controlled trials are warranted to validate the appropriate timing of postoperative radiotherapy. Conclusion: Immediate adjuvant radiotherapy led to no significant reduction in the incidence rate of recurrent keloid