Factors Associated With Acute and Chronic Wound Complications in Patients With Soft Tissue Sarcoma With Long-term Follow-up

Karthik, Naveen; Ward, Matthew C.; Juloori, Aditya; Scott, Jacob G.; Mesko, Nathan W.; Shah, Chirag

doi:10.1097/coc.0000000000000421

Cited by 10 publications

(21 citation statements)

References 25 publications

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“…The MWC-rate in our study (26.2% in the whole cohort; 35.9% in lower extremities) was in line with the data from other studies that investigated postoperative complications after multimodal treatment for STS (both neoadjuvant and adjuvant radiotherapy, partly complemented by other modalities) [5,15,[18][19][20][21]. Retroperitoneal STS were not included in most of the studies [13,15,18,20,21,[25][26][27][28].…”

Section: Discussionsupporting

confidence: 85%

“…Furthermore, differences in inclusion of postoperative seroma treated with drainage or aspiration have been detected. Higher MWC-rates in patients treated with neoadjuvant therapy (23.8%-39.7%) compared to patients treated with adjuvant therapy (8.0-23.1%) were observed in various studies [5,13,15,[18][19][20][21]. However, no statistically signi cant difference between patients treated with neoadjuvant and adjuvant therapy was observed in our study.…”

Section: Discussioncontrasting

confidence: 74%

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Postoperative complications and oncologic outcomes after multimodal therapy of localized high risk soft tissue sarcoma

Potkrajcic

Kolbenschlag

Sachsenmaier

et al. 2022

Preprint

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Background Standard therapy for localized high-risk soft tissue sarcoma includes surgical resection and neoadjuvant or adjuvant radiation therapy (+/-chemotherapy and locoregional hyperthermia). No difference in oncologic outcomes for patients treated with neoadjuvant and adjuvant radiation therapy was reported, whereas side effect profiles differ. The aim of this analysis was to analyse oncologic outcomes and wound healing complications in patients treated with multimodal treatment. Methods Oncologic outcomes and major wound complications (MWC, subclassified as wound healing disorder, infection, abscess, fistula, seroma and hematoma) were evaluated in all 84 patients with localized high-risk soft tissue sarcoma undergoing multimodal treatment, and also separately for the subgroup of lower extremity tumors. Clinical factors and treatment modalities (especially neoadjuvant versus adjuvant radiotherapy) were evaluated regarding their prognostic value and impact on postoperative wound complications. Results Oncologic outcome was dependent on tumor localization (worse for retroperitoneal sarcomas) and number of high risk features (tumor size, depth to superficial fascia and grading), but not on therapy sequencing (however with higher risk patients in the neoadjuvant group). Different risk factors influenced different subclasses of wound healing complications. No difference in MWC-rate in the whole cohort was found between patients treated with neoadjuvant and adjuvant radiation therapy (31.4% vs. 18.2%, p = 0.168). Except for wound infections, no significant differences were observed between neoadjuvant and adjuvant therapy. Diabetes was confirmed as a major risk factor for immune-related wound complications. Conclusion Rates of major wound complications in this cohort are comparable to published data, higher rates of wound infections were observed after neoadjuvant radiotherapy. Patient age and diabetes seem to be major risk factors. The number of risk factors for high risk soft tissue sarcoma seem to influence oncologic outcomes. Neoadjuvant treatment increases the risk only for wound infection treated with oral or intravenous antibiotic therapy and appears to be a safe option at an experienced tertiary center in absence of other risk factors.

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Section: Discussionsupporting

confidence: 85%

Section: Discussioncontrasting

confidence: 74%

Postoperative complications and oncologic outcomes after multimodal therapy of localized high risk soft tissue sarcoma

Potkrajcic

Kolbenschlag

Sachsenmaier

et al. 2022

Preprint

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“…to that reported in the literature for standard fractionation radiotherapy. 16 On the NCIC study reported by O'Sullivan et al, acute wound complications were recorded in 35% of patients who received preoperative radiotherapy vs 17% in those that received postoperative radiotherapy. 17 Of the patients who underwent preoperative radiotherapy, 16% of patients required reoperation due to treatment complications.…”

Section: Discussionmentioning

confidence: 97%

Early Outcomes of Preoperative 5-fraction Radiation Therapy for Soft Tissue Sarcoma Followed by Immediate Surgical Resection

Parsai

Lawrenz

Kilpatrick

et al. 2020

Preprint

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Purpose/ Objective: There are limited data regarding the use of hypofractionated radiation therapy (RT) for soft tissue sarcoma. We report early oncologic outcomes and wound complications of patients undergoing preoperative hypofractionated (5 fraction) RT followed by immediate surgical resection. Materials/ Methods: An IRB-approved database of patients treated with preoperative RT for soft tissue sarcoma was queried. Patients treated with a hypofractionated dosing regimen followed by immediate (within 7 days) planned wide surgical resection were identified. Results: Between 2016 to 2019, sixteen patients met eligibility criteria. The median clinical follow-up was 10.7 months (range 1.7-33.2). The median patient age was 64 years old (range 33-88). Ten of the sarcomas were located in the lower extremity, 4 in the upper extremity, and two were located in the trunk. Five patients had metastatic disease at diagnosis. The majority of the patients received a total radiation dose of 30 Gy in 5 fractions (range 27.5-40 Gy) on consecutive days. All patients were planned with IMRT/VMAT. The median time to surgical resection following the completion of RT was 1 day (range 0-7 days). The median time from initial biopsy results to completion of primary oncologic therapy was 20 days (range 16-35). Ten patients achieved R0 resection, whereas the remaining 6 patients achieved R1 resection. Of the 13 patients assessed for local control, no patients developed local failure. Five patients developed wound healing complications (31%), of which only three patients (19%) required return to the operating room. Conclusions: Treatment of soft tissue sarcoma with preoperative hypofractionated RT followed by immediate resection resulted in a median of 20 days from biopsy results to completion of oncologic therapy. Early outcomes demonstrate favorable wound healing. Further prospective data with long-term follow-up is required to determine the oncologic outcomes and toxicity of hypofractionated preoperative RT.

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“…Wounds are classified on the basis of the various factors such as location, borders, size, tissue type, secretion, odor, edema, and pain ( Frykberg and Banks, 2015 ; Wernick and Stawicki, 2018 ). Based on these characteristics, they can be simple or complex, deep or superficial, acute or chronic, sterile or contaminated, or even defined by the type of healing ( Morton and Phillips, 2016 ; Karthik et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of chronic wounds is complex and can include the administration of vascular endothelial growth factor or erythropoietin, which may not always be efficient and present high costs and has short half-life and side effects ( Hong and Park, 2014 ; Arslantas et al, 2015 ; Yu et al, 2018 ). Moreover, the treatment of chronic wounds often requires the use of antimicrobials due to their multifactorial nature ( Karthik et al, 2018 ). Considering this aspect, the development of new therapies for wound healing requires immediate attention.…”

Section: Introductionmentioning

confidence: 99%

Use of Some Asteraceae Plants for the Treatment of Wounds: From Ethnopharmacological Studies to Scientific Evidences

et al. 2018

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Severe wounds result in large lesions and/or loss of function of the affected areas. The treatment of wounds has challenged health professionals due to its complexity, especially in patients with chronic diseases (such as diabetes), and the presence of pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa. Taking this into consideration, the development of new therapies for wound healing requires immediate attention. Ethnopharmacological studies performed in different countries have shown the use of several plants from the Asteraceae family as wound-healing agents. Evidences gained from the traditional medicine have opened new ways for the development of novel and more efficient therapies based on the pharmacological properties of these plants. In this article, we discuss the literature data on the use of Asteraceae plants for the treatment of wounds, based on the ethnopharmacological relevance of each plant. Special attention was given to studies showing the mechanisms of action of Asteraceae-derived compounds and clinical trials. Ageratina pichinchensis (Kunth) R.M. King and H. Rob. and Calendula officinalis L. preparations/compounds were found to show good efficacy when assessed in clinical trials of complicated wounds, including venous leg ulcers and foot ulcers of diabetic patients. The compounds silibinin [from Silybum marianum (L.) Gaertn.] and jaceosidin (from Artemisia princeps Pamp.) were identified as promising compounds for the treatment of wounds. Overall, we suggest that Asteraceae plants represent important sources of compounds that may act as new and efficient healing products.

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Factors Associated With Acute and Chronic Wound Complications in Patients With Soft Tissue Sarcoma With Long-term Follow-up

Abstract: Several factors associated with acute and chronic wound complications were identified in STS patients including timing of RT, tumor site, and reconstruction use. The development of acute wound complications may also be associated with an increased risk of chronic wound complications.

Cited by 10 publications

References 25 publications

Postoperative complications and oncologic outcomes after multimodal therapy of localized high risk soft tissue sarcoma

Postoperative complications and oncologic outcomes after multimodal therapy of localized high risk soft tissue sarcoma

Early Outcomes of Preoperative 5-fraction Radiation Therapy for Soft Tissue Sarcoma Followed by Immediate Surgical Resection

Use of Some Asteraceae Plants for the Treatment of Wounds: From Ethnopharmacological Studies to Scientific Evidences

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