Treatment of refractory keloid by postoperative HDR brachytherapy: An 89-month median follow-up retrospective study.

Background: Between 2009 and 2022, a homogenous cohort of patients at Saint-Louis hospital affected by keloid scars undergone excision surgery followed by HDR brachytherapy on the same day.

Purpose: To assess the percentage of long-term recurrence and look for the presence of influencing factors.

Materials and methods: Inclusion criteria included the presence of one or more keloid scars and histological confirmation of the diagnosis. Exclusion criteria comprised a history of keloid surgery other than simple excision, and the absence of intraoperative direct suturing of the scar.

Results: A total of 87 keloids scare were eligible for the analysis. Median follow-up was 89,7 months (IQR: 60.2-120.2). 34 recurrences (39%) were observed. Of these recurrences, 41% (14 of 34) showed a significant reduction in keloid volume, 29% (10 of 34) returned to the original keloid volume, and 29% (10 of 34) demonstrated an increase in volume. The recurrence-free survival for all cheloid was 0.89 [0.45;0.98] at one year and 0.67 [0.28;0.89] at 5 years. Keloid of the ear compared to other sites (HR = 0.38, 95% CI: 0.17-0.85, p = 0.02) was significantly associated with a lower recurrence risk. Male sex (HR = 2.13, 95% CI: 0.88-5.14, p = 0.09) and prior treatment (HR = 3.44, 95% CI: 0.85-13.89, p = 0.08) were associated with an increased recurrence risk.

Conclusion: With a prolonged follow-up and a rigorous methodology compared to previous studies, our results lead us to preferentially recommend postoperative brachytherapy for keloid located in the ears, especially for women without any previous treatment.