Measuring functional outcome in upper extremity soft tissue sarcoma: Validation of the Toronto Extremity Salvage Score and the QuickDASH patient-reported outcome instruments

Background and Aims: The present standard of care in treating lower extremity soft tissue sarcomas is function-sparing, limb-preserving resection and reconstruction with or without oncological therapy. The aim of this pilot study was to test the suitability and adequacy of the Finnish translations of two functional outcome questionnaires (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society score) and to perform a preliminary investigation of functional outcomes of Finnish lower-limb soft tissue sarcoma patients after operative treatment. Materials and Methods: Between June 2015 and December 2015, consecutive surgically treated outpatients were asked to participate in the study. Demographic, clinical, surgical, and oncological outcome data were collected. Two functional outcome questionnaires were used (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores). A comparative analysis is presented. Results: A total of 19 lower-limb soft tissue sarcoma patients with a mean follow-up time of 2 years and 10 months were included. All (n = 19) invited patients participated in the study. Mean age was 62.3 years. In total, 13 had high-grade sarcomas. Eight wounds were closed directly, four used skin grafts, and five required flap reconstructions. One patient required a tumor prosthesis, and one required a rotationplasty. A total of 14 patients received oncological therapy. No problems or difficulties were reported in using and completing the Finnish versions of the Toronto Extremity Salvage Score or Musculoskeletal Tumor Society questionnaires. The overall Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores were 88 and 76, respectively. Conclusion: This pilot study suggests that the Finnish versions of the Toronto Extremity Salvage Score and Musculoskeletal Tumor Society questionnaires are suitable for measuring functional outcome after lower extremity soft tissue sarcomas treatment. Functional outcomes vary from moderate to excellent.

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Further validation of the Toronto extremity salvage score for lower extremity soft tissue sarcoma based on Finnish patients

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.08.007 ◽

2020 ◽

Author(s):

Gilber Kask ◽

Mikko M. Uimonen ◽

Ian Barner-Rasmussen ◽

Erkki J. Tukiainen ◽

Carl Blomqvist ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Lower Extremity ◽

Extremity Soft Tissue Sarcoma ◽

Toronto Extremity Salvage Score ◽

Extremity Salvage

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Cross-Cultural Adaptation, Translation, and Validation of the Toronto Extremity Salvage Score for Extremity Bone and Soft Tissue Tumor Patients in Netherlands

Sarcoma ◽

10.1155/2017/6197525 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Julie J. Willeumier ◽

C. W. P. G. van der Wal ◽

Robert J. P. van der Wal ◽

P. D. S. Dijkstra ◽

Thea P. M. Vliet Vlieland ◽

...

Keyword(s):

Soft Tissue ◽

Physical Function ◽

Short Form ◽

Intraclass Correlation ◽

Retest Reliability ◽

Sf 36 ◽

Toronto Extremity Salvage Score ◽

Patient Reported ◽

Test Retest Reliability ◽

Extremity Salvage

Purpose. The aim of this study was to translate and culturally adapt the Toronto Extremity Salvage Score (TESS) to Dutch and to validate the translated version. Methods. The TESS lower and upper extremity versions (LE and UE) were translated to Dutch according to international guidelines. The translated version was validated in 98 patients with surgically treated bone or soft tissue tumors of the LE or UE. To assess test-retest reliability, participants were asked to fill in a second questionnaire after one week. Construct validity was determined by computing Spearman rank correlations with the Short Form- (SF-) 36. Results. The internal consistency (0.957 and 0.938 for LE and UE, resp.) and test-retest reliability (intraclass correlation coefficients 0.963 and 0.969 for LE and UE, resp.) were good for both questionnaires. The Dutch LE and UE TESS versions correlated most strongly with the SF-36 physical function dimension (r=0.737 for LE, 0.726 for UE) and the physical component summary score (r=0.811 and 0.797 for LE and UE). Interpretation. The Dutch TESS questionnaire for lower and upper extremities is a consistent, reliable, and valid instrument to measure patient-reported physical function in surgically treated patients with a soft tissue or bone tumor.

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Impact of Immobilization on Interfractional Errors for Upper Extremity Soft Tissue Sarcoma Radiation Therapy

Journal of Medical Imaging and Radiation Sciences ◽

10.1016/j.jmir.2019.01.006 ◽

2019 ◽

Vol 50 (2) ◽

pp. 308-316

Author(s):

Aran Kim ◽

Valerie Kelly ◽

Colleen Dickie ◽

Charles Catton ◽

Winnie Li

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Upper Extremity ◽

Extremity Soft Tissue Sarcoma

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Function Preservation After Conservative Resection and Radiation Therapy for Soft Tissue Sarcoma of the Distal Extremity as Evaluated by the Toronto Extremity Salvage Score (TESS)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2013.06.1616 ◽

2013 ◽

Vol 87 (2) ◽

pp. S611

Author(s):

R.J. Cassidy ◽

D.J. Indelicato ◽

C.P. Gibbs ◽

M.T. Scarborough ◽

C.G. Morris ◽

...

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Distal Extremity ◽

Toronto Extremity Salvage Score ◽

Function Preservation ◽

Extremity Salvage

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Functional Outcome Measurement in Patients with Lower-Extremity Soft Tissue Sarcoma: A Systematic Literature Review

Annals of Surgical Oncology ◽

10.1245/s10434-019-07698-w ◽

2019 ◽

Vol 26 (13) ◽

pp. 4707-4722 ◽

Cited By ~ 3

Author(s):

Gilber Kask ◽

Ian Barner-Rasmussen ◽

Jussi Petteri Repo ◽

Magnus Kjäldman ◽

Kaarel Kilk ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Literature Review ◽

Lower Extremity ◽

Functional Outcome ◽

Systematic Literature Review ◽

Outcome Measurement ◽

Extremity Soft Tissue Sarcoma

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Patient Reported Outcomes Following Lower Extremity Soft Tissue Sarcoma Resection with Microsurgical Preservation of Ambulation

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1668116 ◽

2018 ◽

Vol 35 (03) ◽

pp. 168-175 ◽

Cited By ~ 3

Author(s):

Ian MacArthur ◽

Colin McInnes ◽

Kim Dalke ◽

Mohamed Akra ◽

Shantanu Banerji ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Lower Extremity ◽

Limb Salvage ◽

Microsurgical Reconstruction ◽

Tendon Transfers ◽

Extremity Sarcoma ◽

Extremity Soft Tissue Sarcoma ◽

Patient Reported ◽

Independent Ambulation

Background Lower extremity soft tissue sarcoma treatment has evolved from primarily amputation procedures toward limb salvage. This series assesses whether soft tissue sarcoma tissue defects, extensive enough to require microsurgical reconstruction, can reliably result in preservation of ambulation, as well as objectively evaluate functional outcomes utilizing a patient-reported validated scale. It will also look at whether immediate functional muscle reconstructions and tendon transfers can be successful at restoring ambulation, potentially expanding the indications for limb salvage procedures. Methods A retrospective review of all microsurgical reconstructions for limb salvage in lower extremity sarcoma patients was completed at our institution (2009–2013). Patients were additionally asked to complete the Toronto Extremity Salvage Score(TESS) quality of life survey. Results Over a 5-year period, 23 patients (mean age: 53 years) underwent free flap reconstructions for 23 sarcomas (mean follow-up: 14 months). Seventy-eight percent of patients received neoadjuvant radiation. The thigh was the most common tumor site (61%) and three muscles were resected on average. Perforator flaps were most frequently used (61%), and functional muscle transfers or immediate tendon transfers were used in four patients. There were no flap take-backs or failures, and 22 patients achieved independent ambulation. Three patients in the series died, two from metastatic disease found postoperatively and one from local recurrence. A 74% response rate was achieved for the TESS survey, with a mean score of 83. Conclusion Microsurgical reconstruction of lower extremity sarcoma defects enables preservation of independent ambulation. Restoration of function utilizing immediate functional microsurgical reconstructions and tendon transfers should be considered.

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