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

Abstract

Introduction: Increased wound complication rates are attributed to the use of pre-operative radiotherapy. The purpose of this study is to evaluate the incidence of complications with or without pre-operative radiotherapy in our institution.Methods: We retrospectively evaluated 48 adult patients with high-grade extremity soft tissue sarcoma. Twenty-two patients received pre-operative radiotherapy (group A) while 26 patients underwent initial surgery (group B). Complications were defined as major wound complications if they were severe enough to delay the delivery of adjuvant treatment (chemotherapy or radiotherapy) more than eight weeks after surgery or if their resolution required a new surgical intervention.Results: Mean follow-up in group A and group B was 44.3 and 53.8 months, respectively. The incidence of complications of any grade in group A was 45.5% and 53.8% in group B (p: 0.566). Major wound complications in group A and group B occurred in 18% and 23% of the patients (p=0.630), respectively. All patients in group A completed local treatment -radiotherapy and surgery -in 66 days on average. In contrast, in group B post-operative radiotherapy was either delayed or suspended in four patients due to wound complications. This determined that 15.4% of the patients in group B did not receive the local treatment -surgery + radiotherapy -as planned.Conclusions: An increased risk of severe acute wound complications with the administration of preoperative radiotherapy was not observed in patients with soft tissue sarcomas of the extremities. In addition, local treatment completion was not jeopardized with preoperative radiotherapy, as opposed to postoperative radiotherapy.

Low rate of function-limiting side effects with high-dose adjuvant radiotherapy in high-grade soft tissue extremity sarcomas: a retrospective single-center analysis over 10 years

“…Further single-center studies are needed to determine if this is due to clinical parameters or patient samples. Positively consistent with other studies, the occurrence of wound complications did not affect LC, DFS, or OS (Rene et al 2021;Rosenberg et al 2013).…”

“…The main prognostic factor for developing wound complications was tumor size, with a size ≥ 8 cm and ≥ 10 cm being significantly more likely to result in complications, which is consistent with the results of O' Sullivan et al (2002) and Peat et al (1994). In contrast (O'Sullivan et al 2002;Rene et al 2021), no impact was found regarding sarcoma location with a rate of 31.4% for leg and 23.8% for arm. Further single-center studies are needed to determine if this is due to clinical parameters or patient samples.…”

Nomogram Predicting the Risk of Postoperative Major Wound Complication in Soft Tissue Sarcoma of the Trunk and Extremities after Preoperative Radiotherapy

“…Previous studies showed that RT combined with surgery could significantly reduce the rate of local recurrence in high-grade STS [ 4 , 5 ], meaning that the completion of the local treatment of STS is of utmost importance. In postoperative RT studies, it is reported that 15% of patients did not complete the combination treatment as planned due to MaWC [ 3 ]. A 12-week delay rate in receiving postoperative RT is 26% reported by Casabianca et al [ 10 ] and 15% reported by Miller et al [ 11 ].…”

“…We did not find that tumour site was a significant risk factor for MaWC. This might be largely due to the stratification method, in which we divided tumour site into four groups according to guidelines, and made some adjustments to the recent literature that considers the proximal lower limb to be the most important risk factor [ 3 , 8 , 16 ]. As it is difficult to construct a nomogram with such stratification, a two categories method was applied in this study.…”

“…Radiotherapy (RT) combined with surgery can reduce the risk of recurrent disease in high-grade soft tissue sarcoma (STS) and is the standard recommended treatment [ 1 , 2 ]. With the timing of RT, preoperative RT has several potential advantages over postoperative RT in reducing long-term function impairment (fibrosis, joint stiffness, fracture) with lower radiation dose and field, the ability to evaluate tumour response, and without treatment delay or cancellation [ 3 , 4 ]. While preserving the maximal function of the limb with preoperative RT, postoperative acute wound complications occur in 9–35% of cases, which is much lower in postoperative RT [ 5 ], and remain a major concern in the management of STS patients [ 6 , 7 ].…”