The outcome of postoperative radiation therapy following plastic surgical resection of recurrent ear keloid: a single institution experience

Reham Mohamed; Abosaleh Abosaleh Elawadi; Reham Al-Gendi; Safa Al-Mohsen; Shabeer Wani; Ahmed Wafa

doi:10.1186/s43046-022-00105-8

The outcome of postoperative radiation therapy following plastic surgical resection of recurrent ear keloid: a single institution experience

J Egypt Natl Canc Inst. 2022 Jan 24;34(1):4. doi: 10.1186/s43046-022-00105-8.

Authors

Reham Mohamed^{1

2}, Abosaleh Abosaleh Elawadi^{3

4}, Reham Al-Gendi³, Safa Al-Mohsen³, Shabeer Wani⁵, Ahmed Wafa⁵

Affiliations

¹ Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt. dr.reham71@hotmail.com.
² Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia. dr.reham71@hotmail.com.
³ Medical Physics Section, Radiation Oncology Department, Comprehensive Cancer Center, KFMC, Riyadh, Saudi Arabia.
⁴ Medical Physics Section, Clinical oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
⁵ Plastic Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia.

PMID: 35067821
DOI: 10.1186/s43046-022-00105-8

Abstract

Background: Ear keloids are abnormal continuously growing healing process following cutaneous injury. Surgical excision is the standard treatment strategy; however, 50-80% of cases develop recurrence. Adjuvant radiotherapy (RT) is commonly offered with a marked decrease in the recurrence rate. The variation in RT protocols used in different studies leads to a bias of results analysis. The aim is to present our experience of using surgical excision with postoperative radiotherapy for recurrent ear keloids. Also, studying different variables especially dose and keloid size that affects recurrence rate. Radiotherapy complications were reported and assessed.

Patients and methods: Keloids between 2006 and 2021 were retrospectively reviewed. Fifty-five ear keloids out of 83 cases who received RT after surgical excision were included in the study. Different dose regimens including 13 Gy/1fx, 8 Gy/1fx, 10 Gy/2fx, 15 Gy/3fx, and other fractionated regimens were used. The Median follow-up period was 35 months. Recurrence-free rate (RFR), side effects, and prognostic factors were assessed.

Results: The overall 2-year RFR was 88 ± 5%. The 2-year RFR was 83 ± 8% for dose regimens with biological effective dose (BED) ≤ 40 and 92 ± 5% for regimens with BED > 40 Gy with an insignificant p value. The 2-year RFR was 74 ± 10% compared to 97 ± 3% for keloids > 2 cm and keloids ≤ 2 cm respectively (p value 0.02). The higher dose used for keloids with > 2 cm size significantly improved RFR. The orthovoltage therapy showed marginally better 2-year RFR compared to electron beam therapy; however, statistically insignificant (p value 0.09). The side effects were minimal with no reported second malignancy or serious G3-4 complications.

Conclusion: Excision followed by RT is a safe and effective treatment for recurrent ear keloids. Low and modest radiation doses are effective; however, a higher dose is recommended for keloids > 2 cm. We recommend a prospective larger-scale study to test the effect of dose and keloid size on the treatment results.

Keywords: Keloid; Orthovoltage; Postoperative; Radiotherapy.

MeSH terms

Humans
Keloid* / pathology
Keloid* / radiotherapy
Keloid* / surgery
Plastics
Prospective Studies
Radiotherapy, Adjuvant
Recurrence
Retrospective Studies
Treatment Outcome

Substances

Plastics