Neoadjuvant Radiotherapy-Related Wound Morbidity in Soft Tissue Sarcoma: Perspectives for Radioprotective Agents

Callaghan, Cameron; Hasibuzzaman, M.M.; Rodman, Samuel N.; Goetz, Jessica E.; Mapuskar, Kranti A.; Petronek, Michael; Steinbach, Emily J.; Miller, Benjamin J.; Pulliam, Casey; Coleman, Mitchell C.; Monga, Varun; Milhem, Mohammed; Spitz, Douglas R.; Allen, Bryan G.

doi:10.3390/cancers12082258

Cited by 14 publications

(18 citation statements)

References 181 publications

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“…Avoiding irradiated tissue at the donor site and recruiting enough tissue while avoiding high-tension closures is a proven strategy that limits complication rates. 14,15 Local FFs are an option that meets the demands of this reconstructive modality. Described in 1987 by Wang et al, 16 using the research and knowledge of anteromedial thigh vascularity 17 in addition to other previously proposed pedicled anteromedial thigh flaps, came a technique to reconstruct vaginal and perineal defects using a pedicled FF.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Acquired Defects of the External Genitalia

et al. 2023

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Purpose Patients undergoing resection of the external genitalia are often faced with significant deformity and decreased quality of life. Plastic surgeons are tasked with the challenge of reconstructing these defects to minimize morbidity and increase patients' quality of life. The authors have set out to investigate the efficacy of local fasciocutaneous and pedicled perforator flaps in external genital reconstruction. Methods A retrospective review was conducted of all patients undergoing reconstruction of acquired defects of the external genitalia from 2017 to 2021. In total, 24 patients met inclusion criteria for the study. Patients were allocated into 2 cohorts: patients with defects reconstructed using local fasciocutaneous flaps (FF) versus patients with defects reconstructed using pedicled islandized perforator flaps (PF). Comorbid conditions, ablative procedures, operative times, flap size, and complications were compared across all groups. Fisher exact test was used to analyze differences in comorbidities, while independent t tests were used to analyze age, body mass index, operative time, and flap size. Significance was set at P < 0.05. Results Of the 24 patients included in the study, 6 underwent reconstruction with islandized PFs (either profunda artery perforator or anterolateral thigh), and 18 underwent reconstruction with FFs. The most common indication for reconstruction was vulvectomy for vulvar cancer, followed by radical debridement for infection, and lastly penectomy for penile cancer. The PF cohort had a significantly higher percentage of previously irradiated patients (50% vs 11.1%, P = 0.019). Although mean flap size was larger in the PF cohort, this difference did not reach statistical significance (176 vs 143.4 cm2, P = 0.5). Perforator flaps had significantly longer operative times when compared with FFs (237.33 vs 128.99 minutes, P = 0.003). Average length of stay was 6.88 days in FF and 5.33 days in PF (P = 0.624). Complication profile including flap necrosis, wound healing delays, and infection were similar between groups despite a significantly higher rate of prior radiation in the PF cohort. Conclusions Our data suggest that PFs such as profunda artery perforator and anterolateral thigh flaps are associated with longer operative times but may offer a suitable option for reconstruction of acquired defects of the external genital compared with local FFs, especially in the setting of prior radiation.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of Acquired Defects of the External Genitalia

et al. 2023

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“…In respect of oncological prognosis, preoperative RT would be preferable for the completion of local treatment without interruption from wound complication. However, the high risk of postoperative wound complication in preoperative RT compared with postoperative RT remains a substantial challenge [ 7 , 12 , 13 ]. With respect to the quality of life, function and oncologic outcomes, it is believed that MaWC needing a secondary procedure should be assessed separately.…”

Section: Discussionmentioning

confidence: 99%

“…With the timing of RT, preoperative RT has several potential advantages over postoperative RT in reducing long-term function impairment (fibrosis, joint stiffness, fracture) with lower radiation dose and field, the ability to evaluate tumour response, and without treatment delay or cancellation [ 3 , 4 ]. While preserving the maximal function of the limb with preoperative RT, postoperative acute wound complications occur in 9–35% of cases, which is much lower in postoperative RT [ 5 ], and remain a major concern in the management of STS patients [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Nomogram Predicting the Risk of Postoperative Major Wound Complication in Soft Tissue Sarcoma of the Trunk and Extremities after Preoperative Radiotherapy

Ouyang

Trent

McCarthy

et al. 2022

Cancers

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Preoperative radiotherapy increases the risk of postoperative wound complication in the treatment of soft tissue sarcoma (STS). This study aims to develop a nomogram for predicting major wound complication (MaWC) after surgery. Using the Oxford University Hospital (OUH) database, a total of 126 STS patients treated with preoperative radiotherapy and surgical resection between 2007 and 2021 were retrospectively reviewed. MaWC was defined as a wound complication that required secondary surgical intervention. Univariate and multivariate regression analyses on the association between MaWC and risk factors were performed. A nomogram was formulated and the areas under the Receiver Operating Characteristic Curves (AUC) were adopted to measure the predictive value of MaWC. A decision curve analysis (DCA) determined the model with the best discriminative ability. The incidence of MaWC was 19%. Age, tumour size, diabetes mellitus and metastasis at presentation were associated with MaWC in the univariate analysis. Age, tumour size, and metastasis at presentation were independent risk factors in the multivariate analysis. The sensitivity and specificity of the predictive model is 0.90 and 0.76, respectively. The AUC value was 0.86. The nomogram constructed in the study effectively predicts the risk of MaWC after preoperative radiotherapy and surgery for STS patients.

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“…Several reports in literature indicated that lower extremities STS have higher rates of wound complications, bone fracture, and joint contracture, which could affect patients' quality of life [38]. Houdek et al published a study on 62 patients with STS of the foot and ankle, with 16 and 15 patients receiving neoadjuvant and adjuvant irradiation (BT was used in 4 patients), respectively.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant high-dose-rate interstitial brachytherapy for malignant peripheral nerve sheath tumor of the foot: a case report

Vavassori¹,

Pennacchioli²,

Augugliaro³

et al. 2021

jcb

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Soft tissue sarcomas of the foot are extremely rare and can therefore be misdiagnosed as benign diseases, and be prematurely removed with an unplanned excision. The standard treatment is a wide local excision with an addition of radiotherapy as an alternative to a radical resection (e.g., below-knee or foot amputation). We report on a patient with primary malignant peripheral nerve sheath tumor in the foot plantar soft tissue, who had no evidence of the disease and no severe late toxicity higher than grade 2, 40 months after receiving amputation of toes and adjuvant interstitial high-dose-rate brachytherapy (HDR-BT). To the best of our knowledge, only a few cases were treated with HDR-BT with this scenario. From our findings, HDR-BT could be a safe and quick treatment option for these types of lesions.

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Neoadjuvant Radiotherapy-Related Wound Morbidity in Soft Tissue Sarcoma: Perspectives for Radioprotective Agents

Cited by 14 publications

References 181 publications

Reconstruction of Acquired Defects of the External Genitalia

Reconstruction of Acquired Defects of the External Genitalia

Nomogram Predicting the Risk of Postoperative Major Wound Complication in Soft Tissue Sarcoma of the Trunk and Extremities after Preoperative Radiotherapy

Adjuvant high-dose-rate interstitial brachytherapy for malignant peripheral nerve sheath tumor of the foot: a case report

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