Should We Do Postoperative Radiotherapy After Keloid Excision as Soon as Possible? A Systematic Review and Meta-Analysis.

backgroundThere is no consensus on the timing of postoperative radiotherapy for keloid.

objectiveWe conducted this meta-analysis to investigate the appropriate time of radiotherapy for keloid in the first 24 hours after operation and identify the potential risk factors. MATERIALS AND

methodA systematic review and meta-analysis were conducted on observational studies by searching PubMed, Embase, and the Cochrane Library. The pooled estimate of the keloid recurrence rate was calculated using a random-effects model. Subgroup analyses were conducted based on time, overtime, BED, length, and location of keloid.

resultsEight observational studies with 507 keloids met the inclusion criteria, and 7 studies were finally included in this study after sensitivity analysis. The recurrence rate was lower in the 2 hours postoperative radiotherapy group (7% CI 2-14%) than in the 6 hours postoperative radiotherapy group (16%, CI 3-36%) (P<0.01). In HDR subgroup analysis, the 2 hours group was better than the 6 hours group ((5%, CI 1-14%) versus (16%, CI 3-36.1%) (P<0.01). Subgroup analysis based on BED indicated that the BED 30 group (5%, CI 1-14%) had a lower recurrence rate than the BED 20 group (6%, CI 0-21%) and the BED 15 group (26%, CI 19-33%) (P<0.01). The keloid length >5 cm subgroup (10.4%, CI 0.4-29%) showed a higher recurrence rate than the keloid length <5 cm group (9.9%, CI 0-41%) (P=0.011).

conclusionImmediate postoperative radiotherapy within 2 hours significantly decreased recurrence rate than postoperative radiotherapy within 6 hours. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .