Which Adjuvant Modality Is Superior after Auricular Keloid Excision: Radiotherapy or Triamcinolone? A Systematic Review and Meta-Analysis

Background: Comparative evidence regarding the effectiveness of adjuvant intralesional triamcinolone versus radiotherapy for auricular keloids remains limited. Objective: To compare adjuvant triamcinolone injection and radiotherapy in preventing recurrence after auricular keloid excision as measured by regrowth of keloid tissue with a minimum follow-up of 6 months. Methods: A systematic review and meta-analysis of PubMed, Embase, Cochrane Library, and Scopus identified studies of auricular keloids treated with excision plus adjuvant radiotherapy or triamcinolone. Non-English articles, case series with fewer than 10 patients, and combined treatments were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale, and pooled recurrence rates were calculated with random-effects models. Results: Forty-five studies (1,885 lesions) were analyzed. Overall recurrence was comparable (triamcinolone: 12% [95% CI: 0.06–0.18] vs. radiotherapy: 13% [0.06–0.21]; p = 0.83). Triamcinolone recurrence varied by follow-up (≤1 year: 36% [0.24–0.49] vs. >3 years: 20% [0.11–0.33]; p < 0.001), while radiotherapy remained stable. Subgroup analyses showed no significant differences for injection timing or radiation dose. Conclusions: In this study, the findings suggest that radiotherapy provides durable and superior effectiveness per treatment, whereas triamcinolone requires 4–6 monthly injections and shows progressive loss of long-term effectiveness. Individualized treatment selection that prioritizes long-term stability and treatment frequency is recommended.