Soft Tissue Sarcomas: Is Pre-operative Radiotherapy Associated With More Acute Wound Complications?

10069 Background: Treatment of soft tissue sarcomas (STS) is characterized by high rates of local control, but poor overall survival because of distant relapses and high rates of wound complications, when preoperative radiation is used. The objective of this study was to test the effectiveness of a protocol with neoadjuvant chemotherapy for STS. Methods: A phase II single-arm prospective trial was carried out. Only adult patients with high grade extremity lesions and tumors deep and larger than 5 cm were included. A total of four cycles of chemotherapy was administered pre-operatively. The chemotherapeutic regimen was: ifosfamide – total of 9.0 g/m2 per cycle, infused in 2 hours from Day 1 to Day 5 (1.8 mg/m2/day). Half of the equivalent dose of mesna was infused 15 min pre-ifosfamide and 4 hours post-ifosfamide. Doxorubicin – total of 60mg/m2 per cycle, was infused in bolus on Day 1. Filgrastima 300 mcg, SC, was administered after the last dose of chemotherapy for 5 days. Radiation was given after surgery. Toxicity was classified by the NIH Toxicity Criteria and response was determined by the RECIST criteria. The others endpoints were the amputation and the wound-related complication rates. Results: Between January, 2005 and May, 2011, 42 patients were included. 21(50%) patients have completed the 4 cycles. Nineteen patients (45.2%) have grade 3 or 4 toxicity, and one (2.3%) death related to treatment had occurred. Between severe complications, febrile neutropenia was the most frequent. By using the RECIST criteria, we observed 10(24.5%) cases of progression, 24(58.5%) cases of stable disease, and 7(17%) partial responses. No complete clinical or radiological response was observed. In the pathological analysis of the surgical specimens, 4(9.7%) cases showed no residual disease (complete pathological response), and a total of 6 (14.6%) showed ≤ 5% of viable residual cells. The amputation rate was 4.8% (2 cases) and complications related to the wound were observed in 9 patients (21.9%). Conclusions: The protocol showed a good rate of objective and pathological response, low rate of complications related to the operative wound, and maintained an acceptable amputation rate. On the other hand, we observed high rate of progression, by RECIST criteria.

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Preoperative Radiation Performed at a Tertiary Center May Lead to Decreased Wound Complications Following Resection in Patients With Soft Tissue Sarcomas

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.06.189 ◽

2017 ◽

Vol 99 (2) ◽

pp. S78

Author(s):

C.M. Ellison ◽

M. Bedi ◽

C. Johnstone

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Wound Complications ◽

Preoperative Radiation ◽

Tertiary Center

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Wound complications after resection and immediate postoperative brachytherapy in the management of soft-tissue sarcomas

European Journal of Surgical Oncology ◽

10.1016/s0748-7983(96)92078-8 ◽

1996 ◽

Vol 22 (1) ◽

pp. 122

Author(s):

Rory R. Dalton ◽

Rachelle M. Lanciano ◽

John P. Hoffman ◽

Burton L. Eisenberg

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Wound Complications

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Delayed wound complications following pre-operative radiotherapy for soft tissue sarcomas

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2017.10.192 ◽

2017 ◽

Vol 43 (11) ◽

pp. 2240-2241

Author(s):

Nikolaos Memos ◽

Anna-Maria Shiarli ◽

Henry Smith ◽

Myles Smith ◽

Winan van Houdt ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Wound Complications

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Wound Complications of Adjuvant Radiation Therapy in Patients with Soft-Tissue Sarcomas

Annals of Surgery ◽

10.1097/00000658-198907000-00014 ◽

1989 ◽

Vol 210 (1) ◽

pp. 93-99 ◽

Cited By ~ 98

Author(s):

MARCIA V. ORMSBY ◽

BASIL S. HILARIS ◽

DATTATREYUDU NORI ◽

MURRAY F. BRENNAN

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Wound Complications ◽

Adjuvant Radiation ◽

Adjuvant Radiation Therapy

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Wound Complications After Multimodal Treatment of Soft Tissue Sarcomas

Journal of Global Oncology ◽

10.1200/jgo.18.88200 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 218s-218s

Author(s):

M. Khanevich ◽

A. Khazov

Keyword(s):

Surgical Treatment ◽

Soft Tissue ◽

Radical Surgery ◽

Soft Tissue Sarcomas ◽

Endovascular Embolization ◽

Main Group ◽

Long Term Results ◽

Wound Complications ◽

Control Group ◽

Quick Freezing

Background: Surgical removal of the tumor remains the only 1 radical treatment of patients with soft tissue sarcomas of the extremities. However, the parameters of total and disease-free survival after this type of treatment cannot be considered satisfactory. Currently the active search and introduction into clinical practice of additional impact methods that can improve the immediate and long-term results of treatment of such patients is being conducted. Aim: To evaluate the risk of the wound process complications after surgical treatment of soft tissue sarcomas using endovascular embolization and cryosurgery. Methods: We have assessed the quantity and quality of postoperative complications of wound process in 199 patients with soft tissue sarcomas and their recurrences. The study group consisted of 53 patients, who underwent radical surgery with selective preoperative endovascular embolization and intraoperative cryosurgery. The control group consisted of 146 patients who had radical surgery without any additional methods. Preoperative embolization and cryosurgery on the wound bed after tumor removal was used to prevent local recurrence of soft tissue sarcomas. Preoperative angiography with selective embolization of vessels feeding the tumor was performed 1-1.5 hours before the main surgical treatment. Cryosurgery was carried out by the method of “Olympic rings” with 3 minutes duration. The temperature of exposure was −186°C. In the course of cryosurgery we adhere to the principle of “quick freezing - an independent slow thawing”. All postoperative wounds tightly sutured with silicone drains by Redon, if necessary. Results: Complications of wound healing have been diagnosed in 15 (28.3%) patients of the main group and in 34 (23.3%) control group patients. Inflammatory-suppurative complications were observed in the remaining 8 (15.1%) patients of the main group and in 18 (12.3%) control group patients ( P > 0.05). Long lymphorrhea was observed in 6 (11.3%) patients of the main group and 11 (7.5%) control group patients. Bleeding in the postoperative period was observed in 1 (1.9%) case of main group patients and in 5 (3.4%) cases of control group. Conclusion: The additional using of selective preoperative endovascular embolization and cryosurgery is safe and does not worsen immediate results of surgical treatment of soft tissue sarcomas.

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Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database

Journal of Oncology ◽

10.1155/2020/7282846 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Kathryn E. Gallaway ◽

Junho Ahn ◽

Alexandra K. Callan

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Soft Tissue Sarcomas ◽

Surgical Site Infections ◽

Small Sample ◽

Wound Complications ◽

Complication Rates ◽

Improvement Program ◽

Primary Bone ◽

Tract Infections

Background. Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Purpose. This study uses a large national registry to characterize the incidence of complications and mortality in the first thirty days following surgical management of primary bone and soft tissue sarcomas of the extremities. Methods. A retrospective review of patients in the National Surgical Quality Improvement Program database was performed. Cases were identified using diagnosis codes for malignant neoplasm of soft tissue or bone and procedure codes for amputation and radical resection. The cohort was subdivided by bone versus soft tissue sarcoma, upper versus lower extremity, and amputation versus limb salvage. Results. One thousand, one hundred eleven patients were identified. The most frequent complications were surgical site infections, sepsis, and venous thromboembolism. The overall incidence of complications was 14.0%. Unplanned readmission and reoperation occurred after 7.0% and 8.0% of cases, respectively. Thirty-day mortality was 0.3%, with one intraoperative death. Patient factors and complication rates varied by tumor location and surgical modality. Lower extremity cases were associated with higher rates of wound complications and infectious etiologies such as surgical site infections, urinary tract infections, and systemic sepsis. In contrast, patients undergoing amputation were more likely to experience major medical complications including acute renal failure, cardiac arrest, and myocardial infarction. Conclusion. Approximately 1 in 7 patients will experience a complication in the first thirty days following surgery for primary bone and soft tissue sarcomas of the extremities. The unique risk profiles of lower extremity and amputation cases should be considered during perioperative planning and surveillance.

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