Abstract
BACKGROUND: Although post-surgical radiotherapy is common in keloid management, factors influencing its efficacy remain unclear. The aim of this study is to investigate postoperative electron beam radiotherapy's impact on recurrence and adverse effects. METHODS: A retrospective study was conducted to evaluate the recurrence rates and complications across three radiation schemes: 17.5 Gy / five fractions, 20 Gy / four fractions, and 18 Gy / two fractions. RESULTS: The overall recurrence rate was 6.5%, with the lowest recurrence (2.8%) observed in the 18 Gy / two-fraction regimen. Radiation schemes, lesion condition (type, location, and duration), and family history were associated with post-surgical recurrence. Furthermore, hyperpigmentation (32%) and dermatitis (11.8%) were identified as significant adverse events. No radiation-related cancers were observed during follow-up. CONCLUSION: The 18 Gy / two-fraction regimen post-surgical electron beam radiotherapy emerged as the most effective and safe option for keloid recurrence prevention. Features, including lesion type, location, family history and disease duration should be combined to guide therapeutic strategy.