title: Postoperative radiotherapy in the management of keloids.
abstract: BACKGROUND
  The high recurrence rate following keloid resection has generated interest in adjuvant treatments for this disease.
  
  
  OBJECTIVE
  This study assesses keloid recurrence when treated with surgery and adjuvant radiotherapy.
  
  
  METHODS
  Retrospective analysis of resected keloids in patients referred to a Chilean radiation oncology centre between 2006 and 2013. Local recurrence was defined as new tissue growth on the surgical scar margin.
  
  
  RESULTS
  Around103 keloids were analysed in 63 patients treated with 15 Gy in three fraction radiotherapy which was initiated on the same day as the surgery (75% of cases). The median keloid diameter was 6 cm; the most common site was thoracic (22%); the most common cause was prior surgery (35%); 37% caused symptoms, and several (47%) had received prior treatment with corticosteroids (32%), or surgery (30%). The median follow-up was three years, and 94% of recurrences occurred during the first year following treatment. Uni and multivariate analyses showed that an absence of symptoms was a protective factor for recurrence (OR: 0.24), while the time interval from onset to treatment with surgery plus radiotherapy >4.2 years was a risk factor (OR: 2.23). The first year recurrence rate was 32% and stabilised at 32% by the second year with no recurrences after 15 months.
  
  
  CONCLUSIONS
  The combination of surgery and radiotherapy proved to be a good therapeutic alternative in the management of keloids. Our results are similar to those described in the literature for a dose of 15 Gy. Given these results, our centre will implement a new dose escalation protocol to improve future outcomes.
authors.affiliation: Servicio de Radioterapia, Clínica IRAM, Santiago 7630595, Chile.
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Carvajal
authors.affiliation: Servicio de Cirugía General, Hospital Militar, Santiago, Chile.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Ibarra
authors.affiliation: Servicio de Cirugía General, Hospital Militar, Santiago, Chile.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Arbulo
authors.affiliation: Servicio de Radioterapia, Clínica IRAM, Santiago 7630595, Chile.
authors.forename: Moisés N
authors.initials: MN
authors.lastname: Russo
authors.affiliation: Service de Radiothérapie, Institut Gustave Roussy, París 94805, France.
authors.forename: Claudio P
authors.initials: CP
authors.lastname: Solé
keywords: keloid; radiotherapy; surgery