Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2013

01-05-2013 | Bone and Soft Tissue Sarcomas

Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface

Authors: Elizabeth H. Baldini, MD, MPH, Michelle R. Lapidus, PAC, Qian Wang, PhD, Judith Manola, MS, Dennis P. Orgill, MD, PhD, Bohdan Pomahac, MD, Karen J. Marcus, MD, Monica M. Bertagnolli, MD, Phillip M. Devlin, MD, Suzanne George, MD, John Abraham, MD, Marco L. Ferrone, MD, John E. Ready, MD, Chandrajit P. Raut, MD

Published in: Annals of Surgical Oncology | Issue 5/2013

Login to get access

Abstract

Purpose

Preoperative and postoperative RT for the treatment of high-grade soft-tissue sarcoma result in similar local control and overall survival rates, but morbidities differ. Postoperative RT is associated with a higher rate of long-term fibrosis, edema, and joint stiffness. Preoperative RT is associated with higher rates of wound complications. It is important to identify predictors for major wound complications (MWC) and to develop strategies to minimize this outcome. We reviewed our experience to determine predictors for MWC following preoperative radiotherapy (RT) and surgery for soft-tissue sarcoma.

Methods

Between January 2006 and May 2011, 103 patients with soft-tissue sarcoma of the extremities and trunk were treated with preoperative RT followed by surgery. MWCs were defined as those requiring operative or prolonged nonoperative management. Fisher’s exact test was used to compare rates. Logistic regression was used for multivariable analysis of factors potentially associated with MWCs.

Results

Median tumor size was 8.4 cm (range 2–25). All patients had wide or radical resections. Wound closures were primary in 70 %, a vascularized flap in 27 %, and split-thickness skin graft (STSG) in 3 %. There were 36 MWCs (35 %). Significant predictors for MWCs on univariate analysis included diabetes, tumors >10 cm, tumors <3 mm from skin surface, and vascularized flap/STSG closure. The same four variables were significant predictors on multivariable analysis.

Conclusions

MWCs following preoperative RT and surgery were common. Tumor proximity to skin surface <3 mm is a previously unreported independent predictor, and further strategies to minimize wound complications are needed.
Literature
1.
Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305–15.PubMedCrossRef
2.
Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.PubMed
3.
Pisters PW, Harrison LB, Leung DH, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14(3):859–68.PubMed
4.
5.
O’Sullivan B, Davis A, Turcotte R, et al. Five-year results of a randomized phase III trial of pre-operative vs post-operative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2004 ASCO Annual Meeting Proceedings 2004;22(14S July 15 Supplement):Abstract 9007.
6.
Davis AM, O’Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75(1):48–53.PubMedCrossRef
7.
Stinson SF, DeLaney TF, Greenberg J, et al. Acute and long-term effects on limb function of combined modality limb sparing therapy for extremity soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1991;21(6):1493–9.PubMedCrossRef
8.
Mundt AJ, Awan A, Sibley GS, et al. Conservative surgery and adjuvant radiation therapy in the management of adult soft tissue sarcoma of the extremities: clinical and radiobiological results. Int J Radiat Oncol Biol Phys. 1995;32(4):977–85.PubMedCrossRef
9.
Robinson MH, Spruce L, Eeles R, et al. Limb function following conservation treatment of adult soft tissue sarcoma. Eur J Cancer. 1991;27(12):1567–74.PubMedCrossRef
10.
Karasek K, Constine LS, Rosier R. Sarcoma therapy: functional outcome and relationship to treatment parameters. Int J Radiat Oncol Biol Phys. 1992;24(4):651–6.PubMedCrossRef
11.
Pollack A, Zagars GK, Goswitz MS, et al. Preoperative vs. postoperative radiotherapy in the treatment of soft tissue sarcomas: a matter of presentation. Int J Radiat Oncol Biol Phys. 1998;42(3):563–72.PubMedCrossRef
12.
O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41.PubMedCrossRef
13.
Bujko K, Suit HD, Springfield DS, et al. Wound healing after preoperative radiation for sarcoma of soft tissues. Surg Gynecol Obstet. 1993;176(2):124–34.PubMed
14.
Cheng EY, Dusenbery KE, Winters MR, et al. Soft tissue sarcomas: preoperative versus postoperative radiotherapy. J Surg Oncol. 1996;61(2):90–9.PubMedCrossRef
15.
Korah MP, Deyrup AT, Monson DK, et al. Anatomic tumor location influences the success of contemporary limb-sparing surgery and radiation among adults with soft tissue sarcomas of the extremities. Int J Radiat Oncol Biol Phys. 2012;82(2):933–9.PubMedCrossRef
16.
Cannon CP, Ballo MT, Zagars GK, et al. Complications of combined modality treatment of primary lower extremity soft-tissue sarcomas. Cancer. 2006;107(10):2455–61.PubMedCrossRef
17.
Kunisada T, Ngan SY, Powell G, et al. Wound complications following pre-operative radiotherapy for soft tissue sarcoma. Eur J Surg Oncol. 2002;28(1):75–9.PubMedCrossRef
18.
Tseng JF, Ballo MT, Langstein HN, et al. The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas. Ann Surg Oncol. 2006;13(9):1209–15.PubMedCrossRef
19.
Peat BG, Bell RS, Davis A, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg. 1994;93(5):980–7.PubMed
20.
Kim B, Chen YL, Kirsch DG, et al. An effective preoperative three-dimensional radiotherapy target volume for extremity soft tissue sarcoma and the effect of margin width on local control. Int J Radiat Oncol Biol Phys. 2010;77(3):843–50.PubMedCrossRef
21.
Kuklo TR, Temple HT, Owens BD, et al. Preoperative versus postoperative radiation therapy for soft-tissue sarcomas. Am J Orthop (Belle Mead NJ). 2005;34(2):75–80.
22.
Brant TA, Parsons JT, Marcus RB Jr, et al. Preoperative irradiation for soft tissue sarcomas of the trunk and extremities in adults. Int J Radiat Oncol Biol Phys. 1990;19(4):899–906.PubMedCrossRef
23.
Mack LA, Crowe PJ, Yang JL, et al. Preoperative chemoradiotherapy (modified Eilber protocol) provides maximum local control and minimal morbidity in patients with soft tissue sarcoma. Ann Surg Oncol. 2005;12(8):646–53.PubMedCrossRef
24.
Wang D, Zhang Q, Kirsch DG, et al. RTOG phase II trial of preoperative image guided radiotherapy (IG-RT) for primary soft tissue sarcoma of the extremity: acute toxicity report. Int J Radiat Oncol Biol Phys. 2011;81(2):S117.CrossRef
25.
Cox DR. Analysis of binary data. London: Methuen and Co.; 1970.
26.
27.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. JASA. 1958;53(282):457–81.CrossRef
28.
29.
30.
Dickie CI, Griffin A, Parent A, et al. Phase II study of preoperative intensity modulated radiation therapy for lower limb soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2010;78(3 Suppl):S84–S85 [abstract #181].
31.
Barwick WJ, Goldberg JA, Scully SP, et al. Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection. Ann Surg. 1992;216(5):591–5.PubMedCrossRef
Metadata
Title
Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface
Authors
Elizabeth H. Baldini, MD, MPH
Michelle R. Lapidus, PAC
Qian Wang, PhD
Judith Manola, MS
Dennis P. Orgill, MD, PhD
Bohdan Pomahac, MD
Karen J. Marcus, MD
Monica M. Bertagnolli, MD
Phillip M. Devlin, MD
Suzanne George, MD
John Abraham, MD
Marco L. Ferrone, MD
John E. Ready, MD
Chandrajit P. Raut, MD
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2797-1

Other articles of this Issue 5/2013

Annals of Surgical Oncology 5/2013 Go to the issue

Hepatobiliary Tumors

Early Viral Suppression Predicts Good Postoperative Survivals in Patients with Hepatocellular Carcinoma with a High Baseline HBV-DNA Load

Gastrointestinal Oncology

Perigastric Tumor Deposits in Primary Gastric Cancer: Implications for Patient Prognosis and Staging

Melanomas

Individualized Surgery: Gamma-Probe-Guided Lymphadenectomy in Patients with Clinically Enlarged Lymph Node Metastases from Melanomas

Healthcare Policy and Outcomes

Validation of the Mexican Spanish Version of the EORTC QLQ-H&N35 Instrument to Measure Health-related Quality of Life in Patients with Head and Neck Cancers

Healthcare Policy and Outcomes

Facilitators and Barriers to Teamworking and Patient Centeredness in Multidisciplinary Cancer Teams: Findings of a National Study

Hepatobiliary Tumors

Regional Differences in Gallbladder Cancer Pathogenesis: Insights from a Comparison of Cell Cycle-Regulatory, PI3K, and Pro-Angiogenic Protein Expression