This report is a summary of the presentations that were delivered during the ESTRO Meets Asia 2024 session that was focused on quality assurance, audit and treatment.

Management of keloid lesions poses significant challenges due to their tendency to recur after treatment. The effectiveness of post-operative radiation therapy to enhance local control (LC) has been the subject of various investigations, which have yielded mixed results. A crucial question remains: which patients benefit most from radiotherapy? This study was intended to evaluate the LC rates of keloids that had been treated with surgical intervention followed by radiotherapy, identify recurrence risk factors, and assess the adverse effects associated with radiotherapy.

A team of radiation oncologists at the Ramathibodi Hospital in Bangkok, Thailand (Chuleeporn Jiarpinitnun, MD, Supakiet Piasanthia, MSc, Nattinee Wattakiyanon, MD and Bongkotrat Enchai, MD) conducted a retrospective study of patients who had been diagnosed with keloids and who underwent surgical treatment followed by post-operative radiotherapy. The study comprised patients who had been followed up for a minimum of six months, between January 2010 and December 2021.

A total of 98 keloid lesions experienced by 69 patients were analysed, with a median follow-up period of 23.5 months (range: six to 105 months). The results indicated a two-year LC rate of 54.5%. Notably, a history of recurrence prior to this treatment emerged as a statistically significant risk factor for local recurrence; patients with a prior history of recurrence exhibited an LC rate of only 18%, compared with 95% for those without such a history. In the multivariable analysis, the hazards ratio for previous recurrence on LC was found to be 30.87 (95% confidence interval, 7.34-129.85; p < 0.001). Additionally, skin hyper-pigmentation was identified as a common adverse effect, occurring in 70% of cases.

These findings suggest that post-operative radiation therapy can be an effective treatment option for patients with keloid lesions, as it provides reasonable LC for those without histories of recurrence. However, further prospective studies are essential for patients with prior recurrences to identify the most suitable treatment modalities to achieve optimal LC.

Bongkotrat Enchai, MD

Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology,

Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand