Post-operative KEloids iRradiation (POKER): does the surgery/high-dose interventional radiotherapy association make a winning hand?

Keloid Excision With Primary Closure Combined With Superficial Radiation Therapy (SRT-100)

BACKGROUND

Surgery plus radiotherapy is associated with fewer recurrences after keloid treatment. However, the side effects of radiotherapy are of concern. Superficial radiation therapy has a low energy, targets the skin, and spares deeper structures, making it ideal for keloid treatment. Many studies have reported good outcomes after surgery combined with superficial radiation therapy. This study provided data on Taiwanese patients who underwent keloid excision with simple primary closure and superficial radiation therapy.

METHODS

We retrospectively collected data from patients who underwent keloid excision with postoperative radiotherapy at our hospital. All patients underwent keloid excision and primary wound closure without Z-plasty or a local flap. Subsequently, patients underwent 2 or 3 fractions of superficial radiation therapy (SRT) on postoperative days 0, 1, and 2 (in 3 fractions). We collected data on the patients' preoperative Vancouver Scar Scale (VSS), 2-month follow-up VSS score, recurrence, and side effects.

RESULTS

In total, 16 keloids in 12 patients were treated with excision, primary closure, and superficial radiation therapy. The mean preoperative VSS was 8.69 ± 1.79, whereas the mean 2-month postoperative VSS was 3.56 ± 0.70. Most of the keloids were followed up for more than 6 months. No keloid recurrence was observed. A side effect of radiotherapy is hyperpigmentation of the skin surrounding the surgical scar.

CONCLUSIONS

Keloid excision with primary closure combined with postoperative SRT leads to a good outcome with no recurrence and a shorter incision wound that satisfies patients and reduces the complications of hyperpigmentation.

Effectiveness of postoperative superficial radiotherapy following the keloid-cross-flap surgery for auricular keloid: A prospective cohort study

BACKGROUND AND PURPOSE

Retaining partial keloid skin to make cross flaps (keloid-cross-flap surgery) is a modification of the core excision. This study aimed to compare the effectiveness of superficial radiotherapy versus compression therapy after keloid-cross-flap surgery.

MATERIALS AND METHODS

In this prospective cohort study, auricular keloid patients were consecutively screened from January 2019 to December 2021. They underwent keloid-cross-flap surgery and then enter either the superficial radiotherapy or the compression treatment group. The primary outcome was the one-year keloid recurrence rate. Secondary outcomes included: non-completion rate of adjuvant treatment; Patient and Observer Scar Assessment Scale (POSAS) scores and auricular aesthetics scores, evaluated by a four-point Likert scale (1 = poor to 4 = excellent) of non-recurring patients. Propensity score matching (PSM) was used to eliminate potential confounding factors.

RESULTS

123 patients were included in the superficial radiotherapy group and 128 in the compression treatment group. Non-completion rate was significantly higher in the compression treatment group (17.97 %), while the loss rate was comparable between the two groups. Overall, 13 patients (13.54 %) relapsed in superficial radiotherapy group, while 22 patients (25.58 %) in compression group (p < 0.05). After PSM, 59 patients in each group were analyzed, and the recurrence rate was lower in the superficial radiotherapy group (13.56 %). Of relapse-free patients, no significant difference was found in PSAS scores, OSAS scores or aesthetic scores between the two groups.

CONCLUSION

Keloid-cross-flap surgery could provide favorable morphologic repair of the auricular keloid, and postoperative superficial radiotherapy shows higher compliance and lower recurrence rate comparing to compression treatment.