Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial

Risk Factors for Significant Wound Complications Following Wide Resection of Extremity Soft Tissue Sarcomas

“…Preoperative EBRT combined with IOERT increases the efficacy of radiation to the tumor bed, while ostensibly limiting morbidity to surrounding normal tissue, thus potentially minimizing the long-term adverse effects of radiation treatment [2,10,13]. Previous studies have focused largely on the timing of radiation as the main predictor of woundhealing problems after tumor resection [7,15]. Preoperative radiation, particularly in the lower extremity, has been cited as a risk factor for significant wound complications [3][4][5]15].…”

“…Debate exists regarding the optimal timing, dose, and delivery method of radiation therapy in the treatment of localized sarcoma [7,15]. External beam radiotherapy (EBRT) can be given preoperatively, postoperatively, or in combination.…”

“…However, preoperative therapy may increase the risk of postoperative wound complications. Several well-designed retrospective and prospective studies document the increased incidence of wound breakdown and need for repeat surgery attributed to preoperative EBRT [4,[14][15][16]. Despite the concern over wound complications, our practice has strongly favored a preoperative approach.…”

Prediction of pathologic fracture risk of the femur after combined modality treatment of soft tissue sarcoma of the thigh

“…IM stabilization at the time of index surgery in a femur that has been exposed to radiation and possible periosteal stripping could have deleterious effects on the vascularity of the involved bone by also disrupting the endosteal blood supply. [20][21][22][23] In addition, wound healing problems are common after combined modality treatment of STS of the thigh, especially when the medial compartment is resected after preoperative radiotherapy, 9 which may further justify a decision not to insert hardware at the time of the index procedure. Conversely, in our patient population, approximately 30% of fractures occurred within 2 years of surgery, which suggests that prophylactic stabilization should not be delayed in patients who are at highest risk based on their calculated fracture probability.…”

“…For example, large, deep tumors in the thigh that are likely to be at high fracture risk are also at risk of wound healing complications, particularly after preoperative radiation. 9 The rationale behind the current study was to develop a prognostic model to enable the accurate prediction of the risk of fracture of the femur based on easily defined clinical and treatment parameters. This will subsequently help the surgeon decide whether to prophylactically stabilize the femur in different clinical situations.…”