Assessment of keloids recurrence rate in patients treated by brachytherapy versus electron beam radiotherapy versus surgical excision

Background: Keloidal scars are benign lesions, and treatment is primarily directed toward symptom relief and cosmetic implications. Given the risk factors, clinical appearance and high recurrence rate, there is no universally accepted treatment. Currently, radiotherapy after surgical excision is recognized as the most efficacious modality. The aim was to compare the efficacy, by means of recurrence rates, between surgical excision alone, electron beam radiotherapy performed after surgical excision, and brachytherapy performed after surgical excision. Material: This retrospective observational study included 27 patients with overall 48 keloids. Patients were divided into three groups: Group 1 (8 patients, 15 keloids) underwent surgical excision alone; Group 2 (10 patients, 19 keloids) received excision plus brachytherapy; Group 3 (9 patients, 14 keloids) received excision plus electron beam radiotherapy. Follow-up evaluations were conducted at 6 months and 2 years. Results: Surgery combined with radiotherapy showed significantly lower recurrence rates compared to surgery alone, confirming its superior efficacy. No significant difference was observed between brachytherapy and electron beam radiotherapy ( p = 0.701 for patients, p = n/a for keloids), indicating both are effective options. In the subgroup of keloids >= 5 cm, a trend toward lower recurrence was observed with brachytherapy compared to electron beam therapy. Conclusions: The present study confirms that surgical excision of keloids followed by radiotherapy can be an effective method of keloid treatment. Although no significance was found when comparing the two radiotherapeutic modalities, brachytherapy showed better clinical advantage when treating larger lesion as well as alleviating the symptoms caused by keloids. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)