A New Modification of Combining Vacuum Therapy and Brachytherapy in Large Subfascial Soft –Tissue Sarcomas of the Extremities

Rudert, Maximilian; Winkler, Cornelia; Holzapfel, Boris Michael; Rechl, H.; Kneschaurek, P.; Gradinger, R.; Molls, M.; Röper, Barbara

doi:10.1007/s00066-010-2046-0

Cited by 12 publications

(9 citation statements)

References 41 publications

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“…Consistent with our previous study [20], this study also found that SR predicted for a local control, limb preservation, and a toxicity benefit when compared to IR. Staged reconstruction minimizes radiation to the final closure and utilizes NPWT for temporary closure [20,22,23,24,25], both of which can improve wound healing [26,27,28]. In STS, Sakellariou et al showed that the use of NPWT after surgery can improve length of hospitalization, complication, and infection rates, and the total cost of wound healing treatment In our study, the use of NPWT and improved toxicity in the SR cohort may also contribute to the cost benefit following initial treatment.…”

Section: Discussionmentioning

confidence: 52%

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Naghavi

Gonzalez

Scott

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methods: A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.Results: Median follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).Conclusions: In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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Section: Discussionmentioning

confidence: 52%

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Naghavi

Gonzalez

Scott

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 99%

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

Naghavi

Gonzalez²,

Scott

et al. 2017

jcb

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PurposeAdjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methodsA retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.ResultsMedian follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).ConclusionsIn recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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“…24 To our knowledge there are no data in the existing literature to address this concern. 25 There are numerous reports describing the successful use of NPWT after resection of soft tissue sarcomas in human patients; NPWT has been used as an adjunct to deliver brachytherapy after microscopically incomplete tumour resections 26 and skin graft reconstruction of irradiated wound beds. 27 In our report, a single patient had incomplete tumour resection and was treatment with NPWT; local disease recurrence was not seen but long-term follow-up was limited.…”

Section: Discussionmentioning

confidence: 99%

“…All patients received perioperative cephazolin (22 mg/kg IV; Cephazolin-AFT, AFT Pharmaceuticals, NSW, Aust) followed by cephalexin (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)…”

Section: Postoperative Carementioning

confidence: 99%

Negative pressure wound therapy using a portable single‐use device for free skin grafts on the distal extremity in seven dogs

Aj¹,

Cashmore²,

Marchevsky³

et al. 2016

Aust Veterinary J

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A New Modification of Combining Vacuum Therapy and Brachytherapy in Large Subfascial Soft –Tissue Sarcomas of the Extremities

Abstract: The combination of vacuum and brachytherapy is applicable and safe in the treatment of large subfascial STS.

Cited by 12 publications

References 41 publications

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

Negative pressure wound therapy using a portable single‐use device for free skin grafts on the distal extremity in seven dogs

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