P212 Service evaluation of postoperative radiotherapy for keloid scars from 2010 to 2024

Abstract

Keloids are benign fibroproliferative lesions resulting from abnormal wound healing, causing cosmetic or functional impairment. Despite available treatments, recurrence remains a challenge, particularly following surgical excision alone. Adjuvant post­operative radiotherapy (PORT) has been shown to reduce recurrence when delivered within 24–48 h of surgery. Our aim was to evaluate long-term outcomes of keloid management using surgical excision followed by PORT across a multicentre service over the period 2010–2024. A retrospective multicentre service evaluation was conducted of patients receiving PORT following surgical excision of keloids between 2010 and 2024. Primary endpoints were recurrence rate and median time to first recurrence. In total 126 patients received PORT, with 123 included in the final analysis. Of these, 74 (60.2%) were male and 49 (39.8%) female, and the mean age was 36.5 years. All patients received radiotherapy within 24–48 h postoperatively, with 119 of 126 (94.4%) treated within 24 h. Recurrence occurred in 62 of 123 patients (50.4%), with no statistically significant difference between sexes (P = 0.36). The median time to first recurrence was 332 days. Across 123 patients, 148 keloids were treated. Recurrence rates did not differ significantly by anatomical site (P = 0.08). Higher recurrence rates were observed in keloids on the face (62.5%), back (60%), upper torso (45.5%) and ear (43.2%), compared with the extremities (33.3%), scalp (28.6%), lower torso (22%) and neck (7.7%). Six patients were treated with electrons and 117 with kV photons. PORT remains an effective adjuvant treatment for reducing recurrence following surgery. This multicentre service delivered radiotherapy within internationally recommended timeframes. Ethnicity was not recorded and represents an important confounder. Larger lesions and treatment fields may have contributed to observed recurrence rates, emphasizing the importance of site-specific planning and optimization of protocols in improving long-term local control.