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

Abstract

Although radiation therapy represents a standard of care in the management of soft tissue sarcoma (STS), it may be associated with acute and chronic wound complications. We performed an analysis to identify the rates of these complications as well as associated factors in a cohort of patients treated with modern radiotherapy and surgical techniques. An institutional review board-approved registry was utilized to identify all adult non-metastatic patients treated for STS at a single institution between 2006 and 2015 with a minimum follow-up of one year. Wound complications were documented as acute within the first 90 days following surgery, and chronic afterward. Factors associated with acute and chronic wound complications were analyzed using binomial logistic regression including interaction terms. A total of 271 patients were identified with a median follow-up of 3.2 years. Lower extremity sarcomas (41.7%) were the most common site followed by the thorax/abdomen (23.6%), and upper extremity (14.4%). The most common histologies were liposarcoma, leiomyosarcoma, and undifferentiated/sarcoma NOS. Overall, 72.7% of cases were > 5 cm and 79.3% were deep tumors. A total of 108 (39.9%) patients received radiation and of these, 43 patients (15.9%) received preoperative radiation therapy, with 79.7% of patients having negative margins. At 5 years, the rates of local recurrence, regional recurrence, distant metastases, and overall survival were 19.4%, 6.8%, 32.3%, and 73.6%, respectively. The rate of acute wound complications was 22.1% (n = 60) with trunk vs. extremity (OR = 0.21, 95% CI = 0.10-0.42, P < 0.0001), radiation (OR = 1.86, 95% CI = 1.04-3.33, P = 0.04), pre-operative therapy (OR = 2.19, 95% CI = 1.08-4.33, P = 0.03) demonstrating an association and a trend noted for reconstruction (OR = 1.97, 95% CI = 0.92-4.07, P = 0.07) on univariate analysis. On multivariate analysis adjusting for reconstruction use and tumor size, extremity tumors were associated with increased acute complications in the absence of RT (OR = 2.95, 95% CI = 1.26-7.40, P = 0.02), and RT further increased this risk (OR for extremity tumors RT vs no RT OR = 1.92, 95% CI = 0.92-3.92, P = 0.07). No association was noted with the use of radiation in non-extremity locations (OR = 0.29, 95% CI = 0.04-1.50, P = 0.17). The rate of chronic wound complications was 3.3% (n = 9) with radiation therapy (OR = 5.58, 95% CI = 1.32-37.94, P = 0.03) associated and a trend noted for trunk vs. extremity location (OR = 0.15, 95% CI = 0.008-0.85, P = 0.08) and acute wound complications (OR = 2.94, 95% CI = 0.71-11.48, P = 0.12). Receipt of radiation therapy was associated with acute and chronic wound complications with treatment site also being a factor. Chronic wound complications may be associated with the development of acute wound complication as well. Future studies may focus on strategies to reduce acute complications as well as evaluating the potential benefits of radiation by treatment site, particularly extremity locations.