Outcome analysis of adjuvant radiotherapy after surgical excision in keloids

Keloids are abnormal scars that occur due to an imbalance between an increased synthesis of collagen and extracellular matrix and decreased degradation of these products. When treated inadequately, it leads to excessive scar formation that is a physical and emotional distress. Dysregulation of collagen remodeling leads to excessive scar formation and hence disfiguration. They appear slowly over months and progress beyond the confines of the original wound and do not regress spontaneously. Several treatment modalities like interferons, intralesional steroid injections, cryotherapy, laser therapy, silicone gel sheets have been used in the management of keloids. However a high recurrence rates (>50%) persists with these approaches. Surgical excision alone is ineffective and additional treatment modalities are needed and radiotherapy has been used as part of this combination therapy. Adjuvant post operative radiotherapy aims to prevent local recurrence, by targeting immature fibroblasts resulting in suppression of their proliferation, inhibition of collagen synthesis and thereby reducing the recurrence of keloids. There are not enough studies giving a standard protocol for post-operative radiotherapy. In our study, the patient after surgical excision of keloid will be given low dose radiation of 12Gy in 3 fractions over 3 days, starting within 24 hours of the excision. The patient will be followed-up to assess the recurrence of keloids, wound complications such as infection, dehiscence or erythema, and scar assessment using the Patient and observer scar assessment scale (POSAS) in a 3-monthly interval over a duration of 12 months.