Excision and Radiotherapy

What Is It?

This method involves surgically removing the scar. Then, to prevent recurrence of the scar, radiotherapy is used hours or days following the surgery. Radiotherapy decreases the activity of cells present in the skin that normally produce collagen.

Non-recurrence rate

Strength of Evidence
1
2
3
4
5
Average 80% reduction in scarring
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  2. Rishi, K. S. et al. Single institution experience of postoperative electron beam radiation therapy in the treatment of keloids. Adv Radiat Oncol 6, 100596 (2021).
  3. Fuenmayor, P., Quiñonez, H., Salas, R. & Pujadas, Z. Outcomes of surgical excision and high-dose-rate brachytherapy for earlobe keloids. World J Plast Surg 10, 78–84 (2021).
  4. Akinbiyi, T. et al. Contemporary treatment of keloids: a 10-year institutional experience with medical management, surgical excision, and radiation therapy. Am J Surg 221, 689–696 (2021).
  5. Wang, Y., Ma, J., Zhang, Z. & Shen, H. Combined surgical excision and electron external beam radiation improves the treatment of keloids: a descriptive study. Dermatol Ther 33, e13494 (2020).
  6. Son, Y. et al. Treatment of keloids with a single dose of low-energy superficial X-ray radiation to prevent recurrence after surgical excision: an in vitro and in vivo study. J Am Acad Dermatol 83, 1304–1314 (2020).
  7. Moura Filho, F. R., Assis, G. D. R. R., Pereira, L. S., Buffo, T. H. & Stolf, H. O. Radioterapia com feixe de elétrons adjuvante à cirurgia de queloide gigante recalcitrante na orelha. S&CD 12, (2020).
  8. Liu, Q. et al. Multi-stage surgery combined with radiotherapy for treatment of giant anterior chest wall keloid: a case report. Medicine (Baltimore) 99, e18886 (2020).
  9. Gomes, S. F. N. The efficacy of combined adjuvant radiotherapy with surgical excision in the treatment of keloids. (2020).
  10. Daurade, M. et al. Efficacy of surgical excision and brachytherapy in the treatment of keloids: a retrospective cohort study. Adv Skin Wound Care 33, 1–6 (2020).
  11. Bradshaw, B. et al. Comparison of superficial radiation and HDR brachytherapy following surgical excision for keloid. International Journal of Radiation Oncology, Biology, Physics 108, e232 (2020).
  12. Berman, B. et al. A retrospective registry study evaluating the long-term efficacy and safety of superficial radiation therapy following excision of keloid scars. J Clin Aesthet Dermatol 13, 12–16 (2020).
  13. Yang, X. et al. A novel radiotherapy approach for keloids with Intrabeam. Biomed Res Int 2019, 4693528 (2019).
  14. Petrou, I. G. et al. Keloid treatment: what about adjuvant radiotherapy? Clin Cosmet Investig Dermatol 12, 295–301 (2019).
  15. Ogawa, R., Tosa, M., Dohi, T., Akaishi, S. & Kuribayashi, S. Surgical excision and postoperative radiotherapy for keloids. Scars Burn Heal 5, 2059513119891113 (2019).
  16. Liu, C.-L. & Yuan, Z.-Y. Retrospective study of immediate postoperative electron radiotherapy for therapy-resistant earlobe keloids. Arch Dermatol Res 311, 469–475 (2019).
  17. Jones, M. E., Ganzer, C. A., Bennett, D. & Finizio, A. Surgical excision of keloids followed by in-office superficial radiation therapy: prospective study examining clinical outcomes. Plast Reconstr Surg Glob Open 7, e2212 (2019).
  18. Hsueh, W.-T. et al. Adjuvant radiotherapy after keloid excision: preliminary experience in Taiwan. Ann Plast Surg 82, S39–S44 (2019).
  19. Sruthi, K., Chelakkot, P. G., Madhavan, R., Nair, R. R. & Dinesh, M. Single-fraction radiation: a promising adjuvant therapy to prevent keloid recurrence. J Cancer Res Ther 14, 1251–1255 (2018).
  20. Song, K.-X. et al. Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate. J Zhejiang Univ Sci B 19, 853–862 (2018).
  21. Renz, P. et al. Dose effect in adjuvant radiation therapy for the treatment of resected keloids. Int J Radiat Oncol Biol Phys 102, 149–154 (2018).
  22. Khalid, F. A. et al. The efficacy of excision followed by intralesional 5-fluorouracil and triamcinolone acetonide versus excision followed by radiotherapy in the treatment of ear keloids: a randomized control trial. Burns 44, 1489–1495 (2018).
  23. Jiang, P. et al. Efficacy and the toxicity of the interstitial high-dose-rate brachytherapy in the management of recurrent keloids: 5-year outcomes. Brachytherapy 17, 597–600 (2018).
  24. Bijlard, E. et al. Intralesional cryotherapy versus excision with corticosteroid injections or brachytherapy for keloid treatment: randomised controlled trials. J Plast Reconstr Aesthet Surg 71, 847–856 (2018).
  25. Taheri, A., Molaei, H., Aghili, M., Rahmanpanah, N. & Mirmohseni, A. Outcomes of surgical excision and brachytherapy in intractable keloids. World J Plast Surg 6, 280–284 (2017).
  26. Qiao, X. F. & Li, X. Comparative study of surgical treatment combined with various methods for treatment of ear scar. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 31, 1341–1343 (2017).
  27. Mankowski, P., Kanevsky, J., Tomlinson, J., Dyachenko, A. & Luc, M. Optimizing radiotherapy for keloids: a meta-analysis systematic review comparing recurrence rates between different radiation modalities. Ann Plast Surg 78, 403–411 (2017).
  28. Hoang, D. et al. Surgical excision and adjuvant brachytherapy vs external beam radiation for the effective treatment of keloids: 10-year institutional retrospective analysis. Aesthet Surg J 37, 212–225 (2017).
  29. Hafkamp, C. J. H. et al. Postoperative single-dose interstitial high-dose-rate brachytherapy in therapy-resistant keloids. Brachytherapy 16, 415–420 (2017).
  30. Bennett, K. G., Kung, T. A., Hayman, J. A. & Brown, D. L. Treatment of keloids with excision and adjuvant radiation: a single center experience and review of the literature. Ann Plast Surg 78, 157–161 (2017).
  31. Jiang, P. et al. Perioperative interstitial high-dose-rate brachytherapy for the treatment of recurrent keloids: feasibility and early results. Int J Radiat Oncol Biol Phys 94, 532–536 (2016).
  32. Shen, J. et al. Hypofractionated electron-beam radiation therapy for keloids: retrospective study of 568 cases with 834 lesions. J Radiat Res 56, 811–817 (2015).
  33. R, O. et al. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: effectiveness of the core excision method. Plastic and reconstructive surgery vol. 135 https://pubmed.ncbi.nlm.nih.gov/25719703/ (2015).
  34. Keeling, B. H., Whitsitt, J., Liu, A. & Dunnick, C. A. Keloid removal by shave excision with adjuvant external beam radiation therapy. Dermatol Surg 41, 989–992 (2015).
  35. Wang, Q. et al. Effect of two dose fractionations on postoperative radiotherapy of keloid: an analysis of 107 patients. Beijing Da Xue Xue Bao Yi Xue Ban 46, 169–172 (2014).
  36. Vila Capel, A., Vilar Palop, J., Pedro Olivé, A. & Sánchez-Reyes Fernández, A. Adjuvance in refractory keloids using electron beams with a spoiler: recent results. Rep Pract Oncol Radiother 20, 43–49 (2014).
  37. Van Leeuwen, M. C. E. et al. High-dose-rate brachytherapy for the treatment of recalcitrant keloids: a unique, effective treatment protocol. Plast Reconstr Surg 134, 527–534 (2014).
  38. Rong, L. et al. Long-term results of postoperative electronic irradiation for 53 patients with keloids. Zhonghua Zheng Xing Wai Ke Za Zhi 30, 270–274 (2014).
  39. Chen, Y. et al. Postoperative carbon ion radiotherapy for keloids: a preliminary report of 16 cases and review of the literature. Wounds 26, 264–272 (2014).
  40. Aluko-Olokun, B., Olaitan, A. A., Ladeinde, A. L. & Oginni, F. O. The facial keloid: a comparison of treatment outcome between intralesional steroid injection and excision combined with radiotherapy. Eur J Plast Surg 37, 361–366 (2014).
  41. Sakamoto, T., Oya, N., Shibuya, K., Nagata, Y. & Hiraoka, M. Dose-response relationship and dose optimization in radiotherapy of postoperative keloids. Radiother Oncol 91, 271–276 (2009).
  42. Bukvić-Mokos, Z., Lipozencić, J. & Marinović, B. Different therapeutic modalities in a patient with multiple spontaneously developed keloids--a case report. Coll Antropol 30, 941–944 (2006).
  43. Sclafani, A. P., Gordon, L., Chadha, M. & Romo, T. Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the literature. Dermatol Surg 22, 569–574 (1996).
  44. Norris, J. E. Superficial x-ray therapy in keloid management: a retrospective study of 24 cases and literature review. Plast Reconstr Surg 95, 1051–1055 (1995).
  45. Darzi, M. A., Chowdri, N. A., Kaul, S. K. & Khan, M. Evaluation of various methods of treating keloids and hypertrophic scars: a 10-year follow-up study. Br J Plast Surg 45, 374–379 (1992).
  46. Supe, S. S., Supe, S. J., Rao, S. M., Deka, A. C. & Deka, B. C. Treatment of keloids by 90Sr-90Y beta-rays. Strahlenther Onkol 167, 397–402 (1991).
  47. Sällström, K. O. et al. Treatment of keloids with surgical excision and postoperative X-ray radiation. Scand J Plast Reconstr Surg Hand Surg 23, 211–215 (1989).
  48. Kovalic, J. J. & Perez, C. A. Radiation therapy following keloidectomy: a 20-year experience. Int J Radiat Oncol Biol Phys 17, 77–80 (1989).
  49. Enhamre, A. & Hammar, H. Treatment of keloids with excision and postoperative X-ray irradiation. Dermatologica 167, 90–93 (1983).
  50. King, G. D. & Salzman, F. A. Keloid scars. Analysis of 89 patients. Surg Clin North Am 50, 595–598 (1970).

Side Effects

High
High side effects and adverse reactions

Reviews

1.0
1 Review