Radiotherapy Does Not Impact Long-term Function Following Resection of Soft-tissue Sarcomas of the Hand

Abstract

Background/Aim: Radiotherapy for soft tissue sarcomas (STS) of the hand is thought to be associated with poor function. The aim of this study was to compare the long-term functional outcome in patients with and without radiotherapy. Patients and Methods: At long-term follow-up (mean 10±5 years), 33 (13 males, 20 female) patients, were alive for review. The mean patient age at surgery was 33±17 years and 13 (39%) patients received radiotherapy (mean dose 55±6 Gy). Results: Postoperatively, the mean QuickDASH and MSTS93 were 7±8 and 92±8%, respectively. Comparing patients with and without radiotherapy, there was no difference (p>0.05) between the mean QuickDASH (5±5 vs. 8±9) or MSTS93 (93±9% vs. 91±8%). Surgical complication occurred more commonly in patients with radiotherapy (46% vs. 15%, p=0.10). Conclusion: The use of radiotherapy was associated with a higher rate of complications, however, was not associated with a worse long-term functional outcome in patients with hand STS.Soft tissue sarcomas (STS) of the hand are typically treated with a combination of radiotherapy and surgery (1-19). Often, radiotherapy aids in achieving local tumor control by diminishing microscopic tumor near the surgical bed, and allowing for a planned close margin excision along critical structures (20). However, the use of radiotherapy in this context has been associated with early and late complication rates including wound dehiscence, fibrosis, stiffness/adhesions, edema and potential for radiation associated fractures (2,4,5,7,9,15,17). Furthermore, neoadjuvant radiotherapy is often associated with wound complications whereas adjuvant radiotherapy is associated with fibrosis, edema, and stiffness (3,4,8,9).Given the potential for a high complication rate associated with radiotherapy, it has been presumed that the hand would be at risk for complications secondary to its complex anatomy, need for soft tissue gliding and multiple joints which are required for appropriate hand function (1,3,4,9,17). Although pre-and post-operative radiotherapy are associated with different complications, neither has been definitively shown to have worse functional outcome compared to the other (3, 9). In contrast, there are other reports which demonstrate good functional outcome for the treatment of STS of the distal extremities with radiotherapy (2,5,11,12).Consequently, there is a paucity of data regarding the long-term functional outcome after excision of an STS of the hand with or without radiotherapy. Therefore, the aim of this study was to compare the functional outcome of the treatment in patients with STS of the hand with and without radiotherapy.

Case Report: Adjuvant image-guided radiation therapy reduces surgical invasiveness in malignant peripheral nerve sheath tumors

“…First, it necessitates close surgical margins that are associated with the risk of residual disease and local recurrence ( 6 ). Second, it hinders the precise delivery of high radiation doses in the adjuvant or neoadjuvant radiotherapy setting ( 7 ). This can be circumvented by immobilization systems for accurate and reproducible positioning, rigorous set-up verification, and meticulous planning to ensure precise RT delivery ( 8 ).…”