Systematic review and meta-analysis on safety and effectiveness of postoperative radiotherapy after ear keloid excision

Abstract

Aim: This systematic review and meta-analysis aims to evaluate the efficacy and safety of postoperative radiotherapy following surgical excision, with or without reconstruction by flap, for patients with ear keloids.

Methods: A comprehensive literature search was performed in PubMed, Cochrane Library, ScienceDirect, and EBSCOHost through August 2025. We included randomized controlled trials, cohort studies, and case series involving patients with ear keloids treated with surgical excision and postoperative radiotherapy, with or without flap reconstruction. Data of recurrence, complications, aesthetic outcomes, and patient satisfaction were abstracted and analyzed.

Results: Fourteen studies were included based on the criteria, with 735 treated keloids in total. Pooled recurrence proportions were 7.8% [95% confidence interval (CI): 0.0%-16.0%] in studies reporting excision with flap reconstruction plus postoperative radiotherapy and 20.0% (95%CI: 5.2%-34.8%) in studies reporting excision plus postoperative radiotherapy without flap reconstruction. Reported adverse effects were generally mild, most commonly pigmentary change and hypertrophic scarring; flap-related events were uncommon. However, long-term oncologic risk could not be reliably assessed, as most included studies had limited follow-up and were not designed to detect rare late events. Cosmetic outcomes and patient satisfaction were frequently reported as favorable across the subset of studies that assessed these outcomes.

Conclusion: Postoperative radiotherapy is commonly reported as an effective adjuvant after excision of auricular keloids, with relatively low recurrence and generally mild short-term adverse effects. Cosmetic outcomes and patient satisfaction were frequently favorable, although interpretation is limited by substantial heterogeneity and predominantly non-comparative observational evidence, underscoring the need for well-designed comparative studies with standardized outcome reporting.

Keywords

Ear keloid / excision / flap reconstruction / radiotherapy / recurrence rate / patient satisfaction / aesthetic outcome

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