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<p>The optimal dosing of adjuvant radiotherapy in keloid management remains controversial, particularly regarding the radiobiological nature of keloids (α/β = 10 Gy vs. 3 Gy). This systematic review and dose–response meta-analysis aims to resolve this debate. Analyzing 94&#xa0;patient cohorts (9909&#xa0;lesions) from 57&#xa0;studies, we compared biologically effective dose (BED)<sub>10</sub> versus BED<sub>3</sub> models and employed multivariable meta-regression. The results showed no significant difference in fit between models (∆&#xa0;Akaike information criterion = 0.13), suggesting that clinical heterogeneity outweighs radiobiological distinctions. Using the BED<sub>3</sub> model, a&#xa0;non-linear L‑shaped dose–response curve appeared, plateauing above ~50 Gy. Crucially, multivariable meta-regression identified anatomical location (skin tension) as the sole significant predictor (<i>p</i> &lt; 0.001), with low-tension sites having a&#xa0;70.5% lower recurrence risk than high-tension sites. The BED itself was not significant after adjusting for location (<i>p</i> = 0.104). In conclusion, anatomical tension overrides BED as the primary determinant of keloid recurrence. Future guidelines should prioritize site-specific, tension-based protocols over simple dose escalation.</p>

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Anatomical location overrides biologically effective dose as a predictor of keloid recurrence after adjuvant radiotherapy: a systematic review and meta-regression

  • 期刊论文

  • 发表日期：

    2026年5月28日

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  • Dongxian Lin,
  • Li Duan,
  • Yuanyuan Xu,
  • Yue Liu,
  • Lianzhao Wang

摘要

The optimal dosing of adjuvant radiotherapy in keloid management remains controversial, particularly regarding the radiobiological nature of keloids (α/β = 10 Gy vs. 3 Gy). This systematic review and dose–response meta-analysis aims to resolve this debate. Analyzing 94 patient cohorts (9909 lesions) from 57 studies, we compared biologically effective dose (BED)10 versus BED3 models and employed multivariable meta-regression. The results showed no significant difference in fit between models (∆ Akaike information criterion = 0.13), suggesting that clinical heterogeneity outweighs radiobiological distinctions. Using the BED3 model, a non-linear L‑shaped dose–response curve appeared, plateauing above ~50 Gy. Crucially, multivariable meta-regression identified anatomical location (skin tension) as the sole significant predictor (p < 0.001), with low-tension sites having a 70.5% lower recurrence risk than high-tension sites. The BED itself was not significant after adjusting for location (p = 0.104). In conclusion, anatomical tension overrides BED as the primary determinant of keloid recurrence. Future guidelines should prioritize site-specific, tension-based protocols over simple dose escalation.