Summary

Introducción: Keloids are benign tumours that originate because of an alteration in the normal healing process commonly after surgical injury or tissue trauma. Although frequently they only have aesthetic consequences, they can lead to symptomatology and important functional limitations. When they are severe, they can cause psychological trauma, with important repercussions on the patient's quality of life. Treatment is usually complex because of the high recurrent rate. The most commonly used therapies include intralesional corticosteroid infiltrations, pressotherapy, cryotherapy, laser, silicone gel, antichemotherapy and surgery combined with radiotherapy or other procedures, as surgery alone is not considered effective. Radiation therapy may be administered by external beam therapy (EBT), high dose-rate brachytherapy (HDR-BT) or low dose-rate brachytherapy (LDR-BT), with adjuvant HDR-BT being one of the most recommended techniques when the keloids do not respond to conventional treatments.

Aims: to evaluate the safety and effectiveness of adjuvant HDR-BT in the treatment of keloids compared to other therapeutic alternatives.

Methods: an exhaustive search of the scientific literature was carried out until March 2018 in the main medical databases, including Medline, Embase, CRD, Prospero and Cochrane. The selection of articles was made according to previously established inclusion/exclusion criteria. Relevant data were collected in evidence tables, and a summary of the evidence was carried out using the GRADE system. Recurrence and cutaneous toxicity grade 3 and 4 were considered critical variables. In order to evaluate the risk of bias of the studies, specific tools were used according to the type of study. Both the selection of the studies, as well as the extraction of data and evaluation of the evidence was carried out by two researchers independently and blindly. 

Results, discussion and conclusions: see pdf below