The Influence of Time Interval Between Preoperative Radiation and Surgical Resection on the Development of Wound Healing Complications in Extremity Soft Tissue Sarcoma

Griffin, Anthony M.; Dickie, Colleen; Catton, Charles; Chung, Peter; Ferguson, Peter C.; Wunder, Jay S.; O’Sullivan, Brian

doi:10.1245/s10434-015-4631-z

Cited by 41 publications

(28 citation statements)

References 30 publications

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“…Preoperative radiotherapy was accompanied by a very high risk for local complications, often wound infections, healing problems and dehiscence, which does not depend on the time to surgery or dose. This is in line with previous publications [ 17 – 20 ] and should be communicated to the patient during the process of shared decision-making. The use of modern radiotherapy techniques may lower the risk of local complications [ 21 – 23 ].…”

Section: Discussionsupporting

confidence: 90%

Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival

2018

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BackgroundPreoperative radiotherapy is often used to facilitate excision of soft-tissue sarcomas. We aimed define factors that affect local tumour control and patient survival.MethodsA single institution registry study of 89 patients with non-metastatic soft-tissue sarcomas having preoperative radiotherapy between 1994 and 2014. Radiologic (presence of peritumoural oedema and volume change following radiotherapy) and histopathologic (tumour volume, grade and surgical margin) parameters were recorded. Outcomes were the events of local recurrence, amputation, metastasis and death.ResultsLocal recurrence rate was low (12%) and marginal excision gave equal local control to wide excision. Pelvic localization was associated with a higher risk for amputation. The absence of peritumoural oedema on MRI defined a subgroup of tumours with more favourable oncologic outcome. Reduction of tumour volume following radiotherapy was also associated with better patient survival. Both these radiologic parameters were associated with lower tumour grade. Tumour necrosis was not significant for patient survival. The local complication rate, mainly wound healing problems and infection, was high (40%), but did not lead to any amputation.ConclusionPreoperative radiotherapy of high-risk soft-tissue sarcomas allows for good local control rate at the expense of local wound complications, which are however manageable. Marginal excision is sufficient for local control. Absence of peritumoural oedema on MRI, as well as tumour size reduction following radiotherapy are associated to superior patient survival and can be used ass early prognostic factors.Electronic supplementary materialThe online version of this article (10.1186/s13569-018-0106-x) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival

2018

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“…It is intended to lower WC risk through minimizing residual dead space and also substituting previously irradiated soft tissues with healthy and well-vascularized tissue from a donor site. The literature returns mixed results on the impact of plastic reconstruction on WC risk; some studies conclude that it lowers risk [ 22 ], others find that it increases it [ 4 ], while yet others demonstrate no impact [ 6 ]. Analysis of our patient cohort indicates that reconstruction with vascularized flaps was a statistically significant risk factor for WC.…”

Section: Discussionmentioning

confidence: 99%

Tumor volume is a better predictor of post-operative wound complications compared to tumor size in soft tissue sarcomas of the proximal lower extremity

2016

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BackgroundWide local excision with or without radiation therapy (RT) and chemotherapy is widely accepted as appropriate management for soft tissue sarcomas (STS) of the extremity. Although survival and local control rates are comparable to amputation, post-operative wound complications (WC) following limb salvage can result in significant morbidity for the patient. Certain risk factors such as location, pre-operative RT, and age have been shown to increase the risk of WCs. Somewhat surprisingly, size has not consistently been shown to impact WC rates. The goal of this study is to assess whether tumor volume, as opposed to the traditional measurement of the largest dimension in one plane, correlates with the development of post-operative WCs.MethodsBetween 2000 and 2013, 81 patients with STS of the proximal lower extremity, buttock and pelvis were retrospectively identified from our prospective database. We reviewed the impact of patient, tumor, and treatment variables on postoperative WC. Predictors for WC were evaluated using the Fisher exact test for univariate analysis and logistic regression for multivariate analysis. Tumor volume was determined using the medical image merge (MIM) ® software program (version 6.5.4, MIM Software, Cleveland, OH). Tumor size (diameter) was determined the historical way of measuring the widest dimension on the sagittal, coronal, and axial planes from the MRI scan at midplane.ResultsThe overall WC rate within 6 months of tumor resection was 32 %. WC were more likely to occur with larger tumor volumes (p = 0.015), although not with tumor diameters ≥10 cm (p = 0.55). Neither volume of subcutaneous fat (p = 0.34) or depth of the subcutaneous fat layer (p = 0.82) significantly impacted WC rates. Tumor proximity to skin surface also did not significantly impact WC risk (p = 0.73).ConclusionsIncrease in tumor volume led to a higher risk of post-operative WCs. Assessing tumor volume may allow clinicians to better counsel patients on their risk of post-operative WCs. Tumor volume, as opposed to size alone, should be considered in future sarcoma outcome studies.

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“…A recent phase-2 study performed by the Canadian trialists on wound complication rates of lower extremity STS showed no significant difference in wound complication rates after preoperative IMRT compared with non-IMRT in the NCIC trial (30.5 vs. 43%, P = 0.6). 22 Therefore, the authors speculated that IMRT alone may not represent the main factor influencing wound complications. Wang et al 23 23 Other reasons also may negatively affect wound complications.…”

Section: Discussionmentioning

confidence: 99%

Preoperative IMRT for soft-tissue sarcoma of the extremities and trunk: low rate of wound complications

Studer

Glanzmann

Maduz

et al. 2018

Current Orthopaedic Practice

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Background: The Canadian prospective randomized NCIC SR2 trial tested the sequence of radiation and surgery for extremity soft-tissue sarcoma. The trial was conducted in the era before intensity-modulated radiation therapy (IMRT) was clinically available. Similar disease control after preoperative and postoperative non-IMRT was found. However, the preoperative non-IMRT arm showed significantly less (persisting) late-term effects but increased (transient) wound complication rates compared to the postoperative non-IMRT arm (35% vs. 17%, P = 0.01). Consequently based on these results, preoperative radiation therapy was considered the preferred approach. Currently IMRT, with its option for highly conformal dose distribution that translates into better normal tissue sparing, is used as the general standard for sarcoma radiation therapy in most patients. Our hypothesis was that a lower wound complication rate after preoperative radiation therapy might be achievable in the IMRT era. Methods: We prospectively assessed our preoperative IMRT cohort (n=67 consecutive patients) treated between March 2008 and March 2016 with respect to wound complication rates. Results: Fourteen of 67 (21%) externally referred patients with recurrent (n=1) or incompletely resected disease (n=13), and 53 treatment-naive patients underwent planned preoperative radiation after core biopsy. After mean/median 7.3/7 wk (3-12 wk), complete tumor resection was performed. Secondary revision was required in five of 67 (i.e., wound complication rate of 7%). Two local failures were observed so far. Conclusions: The presented results support our hypothesis that preoperative IMRT may lead to a reduced wound complication rate compared to that after postoperative and mainly preoperative non-IMRT techniques.

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The Influence of Time Interval Between Preoperative Radiation and Surgical Resection on the Development of Wound Healing Complications in Extremity Soft Tissue Sarcoma

Abstract: The time interval between preoperative RT and surgical excision in extremity STS had minimal influence on the development of WCs. Four- or 5-week intervals showed equivalent complication rates between the two groups, suggesting an optimal interval to reduce potential WCs.

Cited by 41 publications

References 30 publications

Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival

Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival

Tumor volume is a better predictor of post-operative wound complications compared to tumor size in soft tissue sarcomas of the proximal lower extremity

Preoperative IMRT for soft-tissue sarcoma of the extremities and trunk: low rate of wound complications

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