Wound Complication Frequency Following Resection of Extremity Soft Tissue Sarcomas after Preoperative Irradiation

2011 ◽  
Vol 81 (2) ◽  
pp. S690
Author(s):  
L.A. Rosenberg ◽  
R. Esther ◽  
J. Tepper
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Wound Complication ◽  
Preoperative Irradiation

Preoperative irradiation for soft tissue sarcomas of the trunk and extremities in adults

1990 ◽  
Vol 19 (4) ◽  
pp. 899-906 ◽  
Author(s):  
Timothy A. Brant ◽  
James T. Parsons ◽  
Robert B. Marcus ◽  
Suzanne S. Spanier ◽  
Travis C. Heare ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Preoperative Irradiation

Preoperative stereotactic ablative body radiotherapy with postoperative conventional irradiation of soft tissue sarcomas: Protocol overview with a preliminary safety report.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23546-e23546
Author(s):  
Mariia Ebert ◽  
Sergey Novikov ◽  
Grigory Zinovev ◽  
Georgy Gafton ◽  
Svetlana Protsenko ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Postoperative Radiotherapy ◽  
Soft Tissue Sarcomas ◽  
Radical Resection ◽  
Wound Complication ◽  
Tumour Volume ◽  
Radiotherapy Planning ◽  
Stereotactic Ablative Body Radiotherapy ◽  
Postoperative Irradiation

e23546 Background: Preoperative radiotherapy in patients with soft tissue sarcomas is characterized by important advantages: high precision of dose delivery, reduction of tumour volume and implantation potential, induction of immunologic response. Postoperative irradiation is associated with a reduced risk of complication, and a comprehensive radiotherapy planning in accordance with the pathologic report. Combination of pre- and postoperative irradiation gives the opportunity to use the best of both methods. Methods: from 06.2018 to 01.2021 24 patients with soft tissue sarcomas of extremities were included in the protocol (NCT04330456) and 14 cases with at least 12 months follow-up were eligible for analysis. Preoperative stereotactic ablative body radiotherapy (SBRT) was performed as 5 fraction of 7 Gy with dose reduction (5 fractions of 5 Gy) on the margins of the tumor. Postoperative radiotherapy started 5-8 weeks after the surgery and was performed as standard compartmental irradiation in 25 fractions of 2Gy. Complications were determined according to CTCAE and wound complication scales. Results: Preoperative SBRT and subsequent radical resection with tumor free surgical margins were performed in all 14 cases. Primary wound closure was mentioned in all patients. Postoperative radiotherapy started 51.8 days (range 33-99 days) days after the surgery. With a relatively short follow-up of 21.5 (13-30) months, we recorded 2 cases (14%) of severe complications (Canadian sarcoma group criteria), and there were no local recurrences. Conclusions: Our preliminary results demonstrate that the combination of preoperative SBRT and postoperative conventional radiotherapy is feasible and does not increase the risk of postoperative complications. Clinical trial information: NCT04330456.

scholarly journals Predictors of Wound Complications following Radiation and Surgical Resection of Soft Tissue Sarcomas

Sarcoma ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Drake G. LeBrun ◽  
David M. Guttmann ◽  
Jacob E. Shabason ◽  
William P. Levin ◽  
Stephen J. Kovach ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Resection ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Soft Tissue Sarcomas ◽  
Wound Complication ◽  
Radiation Dermatitis ◽  
Wound Complications ◽  
Surgery Patient ◽  
Increased Risk

Wound complications represent a major source of morbidity in patients undergoing radiation therapy (RT) and surgical resection of soft tissue sarcomas (STS). We investigated whether factors related to RT, surgery, patient comorbidities, and tumor histopathology predict the development of wound complications. An observational study of patients who underwent STS resection and RT was performed. The primary outcome was the occurrence of any wound complication up to four months postoperatively. Significant predictors of wound complications were identified using multivariable logistic regression. Sixty-five patients representing 67 cases of STS were identified. Median age was 59 years (range 22–90) and 34 (52%) patients were female. The rates of major wound complications and any wound complications were 21% and 33%, respectively. After adjusting for radiation timing, diabetes (OR 9.6; 95% CI 1.4–64.8; P=0.02), grade ≥2 radiation dermatitis (OR 4.8; 95% CI 1.2–19.2; P=0.03), and the use of 3D conformal RT (OR 4.6; 95% CI 1.1–20.0; P=0.04) were associated with an increased risk of any wound complication on multivariable analysis. These data suggest that radiation dermatitis and radiation modality are predictors of wound complications in patients with STS.

scholarly journals Perioperative Management of Extremity Soft Tissue Sarcomas

2018 ◽  
Vol 36 (2) ◽  
pp. 118-124 ◽  
Author(s):  
Rick L. Haas ◽  
Alessandro Gronchi ◽  
Michiel A.J. van de Sande ◽  
Elizabeth H. Baldini ◽  
Hans Gelderblom ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Metastatic Disease ◽  
Local Control ◽  
Systemic Chemotherapy ◽  
Soft Tissue Sarcomas ◽  
Cost Effective ◽  
Wound Complication ◽  
Local Relapse ◽  
The Cost ◽  
Combination Regimens

Surgery is potentially curative for primary nonmetastatic extremity soft tissue sarcomas. After surgery alone, patients may remain at risk for local recurrences and/or metastatic disease. To reduce the likelihood of a local relapse, the addition of radiotherapy (RT) to limb-sparing surgery may result in higher local control rates of at least 85%. Generally, it can be stated that local control after both preoperative and postoperative RT is comparable, but that preoperative RT comes with a more favorable toxicity profile after prolonged follow-up, albeit at the cost of a higher wound complication rate. Furthermore, recent data suggest that preoperative RT is more cost effective. To reduce the risk of subsequent metastatic disease, systemic chemotherapy can be introduced early during the primary management of these patients. These systemic chemotherapy regimens can also be applied both preoperatively and postoperatively. Finally, with the aim of increasing the antitumor response of perioperative RT, these agents may even be combined with RT, concurrently and sequentially. While designing new preoperative combination regimens, responses should be carefully monitored by both sophisticated radiologic and pathologic evaluations. This article reviews all these aspects, in addition to limb-sparing surgery.

scholarly journals Postoperative Wound Complications in Fungating Extremity Soft Tissue Sarcomas

2019 ◽  
pp. 273-279
Author(s):  
Blakely AM ◽  
Chow W ◽  
Sampath S ◽  
Femino JD ◽  
Lozano-Calderon S ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Excision ◽  
Soft Tissue Sarcomas ◽  
Wound Complication ◽  
Wound Complications ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Pleomorphic Sarcoma ◽  
Extremity Soft Tissue Sarcoma ◽  
Clinically Significant

Background: Among deep extremity soft tissue sarcomas, skin ulceration is infrequent. Fungating sarcomas may lead to infection or clinically significant bleeding. Data regarding management of ulcerating sarcomas is lacking. We sought to evaluate the outcomes of different treatments for these tumors.Patients and methods: A retrospective review of patients treated at two sarcoma referral centers with histologically confirmed extremity soft tissue sarcoma was performed from 2000-2018. Patient demographics, clinicopathologic, and treatment factors were analyzed in terms of method of resection, receipt of radiation, and wound complications.Results: Overall, 22 patients had fungating lesions. Most patients were male with tumors of the distal extremity.Median tumor size was 8 cm. Half had undifferentiated pleomorphic sarcoma histology, followed by myxofibrosarcoma (n=5), leiomyosarcoma (n=3), or other (n=3). Fifteen patients (68%) underwent limb-preserving resection, of which 7 underwent adjuvant radiation. Six patients (27%) developed wound complications, which occurred equally between amputation versus local excision (p = 0.93). Among local excision patients, one who received adjuvant radiation developed a wound complication (14%), which was not significantly different from those who did not undergo radiation (n=3 of 8, 38%; p = 0.31).Conclusions: Similar rates of wound complications were seen between amputation and limb-preserving groups.Among patients who underwent local excision, the administration of adjuvant radiation therapy did not significantly increase wound complication rates.

scholarly journals RESULTS OF COMBINED TREATMENT PATIENTS WITH SOFT TISSUE SARCOMAS USING STEREOTACTIC ABLATIVE BODY RADIOTHERAPY

2020 ◽  
Vol 66 (4) ◽  
pp. 413-419
Author(s):  
Georgiy Gafton ◽  
Mariya Ebert ◽  
S. Novikov ◽  
E. Fedosova ◽  
G. Zinovev ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Postoperative Radiotherapy ◽  
Combined Treatment ◽  
Soft Tissue Sarcomas ◽  
Radical Resection ◽  
Wound Complication ◽  
Tumour Volume ◽  
Stereotactic Ablative Body Radiotherapy ◽  
Grade Ii

Preoperative radiotherapy in patients with soft tissue sarcomas characterized by important advantages: high precision of dose delivery, reduction of tumour volume and implantation potential, induction of immunologic response. Postoperative radiotherapy associated with decreased complication rate, delivery of treatment to microscopic disease according to pathologic report. Combination of pre- and postoperative irradiation gives the opportunity to use best of both methods. The aim: analyses of feasibility and safety of radiotherapy protocol that combined pre- and postoperative radiotherapy in patients with soft tissues sarcomas of extremities. Materials and methods: from 06.2018 to 01.2020 ten patients with soft tissue sarcomas of extremities were included in the protocol. Preoperative stereotactic ablative body radiotherapy (SABR) was performed as 5 fraction of 7 Gy on the main tumor volume with dose reduction to 5Gy in 5 fraction on the margins of the field. Postoperative radiotherapy started 5-8 weeks after surgery and was performed as standard compartmental irradiation in 25 fractions of 2Gy. Complications were determined according to CTCAE and wound complication scales. Results: from 06.2018 to 01.2020 10 patients with soft tissue sarcomas of extremities were included in the study. Pre-opeartive SABR and subsequent radical resection with tumor free surgical margins were performed in all 10 cases. Primary wound closure was mentioned in all patients. With relatively short follow-up of 9.1 (3-20) months we didn’t mentioned any case of grade II or more toxicity and no local recurrences. Conclusion: Our preliminary results demonstrate that combination of preoperative SABR and postoperative conventional radiotherapy is feasible and associated with low probability of grade II (and higher) toxicity.

ARST1321: Pazopanib neoadjuvant trial in non-rhabdomysarcoma soft tissue sarcomas: A report of major wound complications.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11059-11059
Author(s):  
Thomas Scharschmidt ◽  
Yen-Lin Chen ◽  
Dian Wang ◽  
Yueh-Yun Chi ◽  
Mark Kayton ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitor ◽  
Kinase Inhibitor ◽  
Soft Tissue Sarcomas ◽  
Wound Complication ◽  
Wound Complications ◽  
High Grade ◽  
Grade Iii

11059 Background: The care of soft tissue sarcomas is complex and multidisciplinary in nature. Even without radiation or chemotherapy wound complications are common after surgical resection with a reported incidence of 6-42%. Wound complication rates with the use of neoadjuvant chemoradiation for high-grade soft tissue sarcomas has been reported and supported in the literature to be approximately 30%. Relevant to this study, a trial evaluating the use of a VEGF receptor inhibitor (bevacizumab) in combination with radiation pre-operatively in soft tissue sarcomas reported a wound complication rate of 25%. ARST 1321 is a phase II/III study evaluating the tyrosine kinase inhibitor Pazopanib +/- chemotherapy and radiation in select high-grade soft tissue sarcomas. The dose-finding phase has been completed and the objective of this report is to detail the major wound complications observed with this protocol. Methods: Patient enrolled on all arms of the study (Pre-operative radiation, +/- pazopanib, +/- doxorubicin and ifosphamide) were evaluated for wound complications (Grade I/II and Grade III). Patient demographics, tumor characteristics, and complication details were compiled and analyzed. Results: There were a total of 130 evaluable patients (100 patients on chemotherapy arm, 30 on non-chemotherapy arm). There were 38 overall wound complications reported (38/130, 29%). 23/38 (60%) occurred on the chemotherapy arm; therefore that cohort had 23/100 (23%) wound complication rate, while the non-chemotherapy cohort had an overall rate of 50% (15/30). Grade III wound complications represented 23/38 (66%) of all the complications. 30/38 (79%) of the complications were in the lower extremity. 23/38 (60%) patients were aged > 18 years. Conclusions: The overall rate of wound complications observed was 29% (38/130) which remains within the accepted historical rate based upon literature review without the use of a tyrosine kinase inhibitor. The overall major wound complication (grade III) rate was 19% (25/130). Also consistent with the literature is the finding that a majority of the complications occurred in the lower extremity. In conclusion, the addition of a tyrosine kinase inhibitor (pazopanib) has a wound complication toxicity profile comparable to current and historical literature. Clinical trial information: NCT02180867.

Treatment of soft tissue sarcomas by preoperative irradiation and conservative surgical resection

1988 ◽  
Vol 14 (4) ◽  
pp. 693-699 ◽  
Author(s):  
H.Thomas Barkley ◽  
Richard G. Martin ◽  
Martin M. Romsdahl ◽  
Robert Lindberg ◽  
Gunar K. Zagars
Keyword(s):  
Soft Tissue ◽  
Surgical Resection ◽  
Soft Tissue Sarcomas ◽  
Preoperative Irradiation
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