Intralesional Keloid Excision Followed by Single Fraction Electron Beam Radiotherapy and Postoperative Local Steroids: a Non-randomized Open Study on Recurrence Rate

After the total excision of keloids, radiation therapy has been demonstrated as one of the most effective treatment methods to prevent a recurrence. This study was aimed to compare the effectiveness and side effects of single fraction electron beam radiotherapy (EBRT) and intra-lesional steroids (ILS) in preventing the recurrence of keloids postoperatively. Those patients who received EBRT within 24 h after the completion of keloid excision from the Plastic Surgery Department in a tertiary care institution in Southern India constituted the first group. The second group consisted of patients who received triamcinolone acetate injection intraoperatively along the wound edges and postoperatively into the scar every 3 weeks for 5 cycles. Both groups of patients were prospectively followed up. Out of 101 patients enrolled in the study, six patients were lost to follow-up. Ten patients developed postoperative complications. At the end of 1 year, 48.4% of all the patients were having a recurrence. The incidence of recurrence in the radiation group and steroid group were 56.5% and 40.8% respectively. Keloids of the ear lobe were having a significantly less number of recurrences at 1 year (8.3% vs 72.9%). There is no statistically significant difference between the outcomes of postoperative EBRT and ILS injection in the recurrence of keloids, although the steroid group had a 15.7% less incidence of recurrence. Keloids of the ear lobe and keloids with lengths less than 2 cm were having significantly less recurrence. About 10% of patients had mild postoperative complications.