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Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Preoperative and postoperative RT for the treatment of high-grade soft-tissue sarcoma result in similar local control and overall survival rates, but morbidities differ. Postoperative RT is associated with a higher rate of long-term fibrosis, edema, and joint stiffness. Preoperative RT is associated with higher rates of wound complications. It is important to identify predictors for major wound complications (MWC) and to develop strategies to minimize this outcome. We reviewed our experience to determine predictors for MWC following preoperative radiotherapy (RT) and surgery for soft-tissue sarcoma.

Methods

Between January 2006 and May 2011, 103 patients with soft-tissue sarcoma of the extremities and trunk were treated with preoperative RT followed by surgery. MWCs were defined as those requiring operative or prolonged nonoperative management. Fisher’s exact test was used to compare rates. Logistic regression was used for multivariable analysis of factors potentially associated with MWCs.

Results

Median tumor size was 8.4 cm (range 2–25). All patients had wide or radical resections. Wound closures were primary in 70 %, a vascularized flap in 27 %, and split-thickness skin graft (STSG) in 3 %. There were 36 MWCs (35 %). Significant predictors for MWCs on univariate analysis included diabetes, tumors >10 cm, tumors <3 mm from skin surface, and vascularized flap/STSG closure. The same four variables were significant predictors on multivariable analysis.

Conclusions

MWCs following preoperative RT and surgery were common. Tumor proximity to skin surface <3 mm is a previously unreported independent predictor, and further strategies to minimize wound complications are needed.

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Acknowledgment

The authors thank Barbara Silver for her editorial assistance.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, USA

    Elizabeth H. Baldini MD, MPH, Karen J. Marcus MD & Phillip M. Devlin MD

  2. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Michelle R. Lapidus PAC, Monica M. Bertagnolli MD & Chandrajit P. Raut MD

  3. Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Dennis P. Orgill MD, PhD & Bohdan Pomahac MD

  4. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Marco L. Ferrone MD & John E. Ready MD

  5. Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Elizabeth H. Baldini MD, MPH, Michelle R. Lapidus PAC, Karen J. Marcus MD, Monica M. Bertagnolli MD, Phillip M. Devlin MD, Suzanne George MD, Marco L. Ferrone MD, John E. Ready MD & Chandrajit P. Raut MD

  6. Beijing Novartis Pharma Co. Ltd., Beijing, China

    Qian Wang PhD

  7. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Judith Manola MS

  8. Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA

    John Abraham MD

  9. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Suzanne George MD

Authors
  1. Elizabeth H. Baldini MD, MPH
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  2. Michelle R. Lapidus PAC
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  3. Qian Wang PhD
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  4. Judith Manola MS
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  8. Monica M. Bertagnolli MD
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  9. Phillip M. Devlin MD
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  14. Chandrajit P. Raut MD
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Corresponding author

Correspondence to Elizabeth H. Baldini MD, MPH.

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Baldini, E.H., Lapidus, M.R., Wang, Q. et al. Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface. Ann Surg Oncol 20, 1494–1499 (2013). https://doi.org/10.1245/s10434-012-2797-1

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  • DOI: https://doi.org/10.1245/s10434-012-2797-1

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