Predictors of Wound Complications following Radiation and Surgical Resection of Soft Tissue Sarcomas.

Drake G Lebrun,Stephen J Kovach,David M Guttmann,William P Levin,Kristy L Weber,Jacob E Shabason

doi:10.1155/2017/5465130

Drake G Lebrun, Stephen J Kovach + Show 4 more

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https://doi.org/10.1155/2017/5465130

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Journal: Sarcoma	Publication Date: Jan 1, 2017
Citations: 28	License type: CC BY 4.0

Affiliation: University of Pennsylvania

Abstract

Wound complications represent a major source of morbidity in patients undergoing radiation therapy (RT) and surgical resection of soft tissue sarcomas (STS). We investigated whether factors related to RT, surgery, patient comorbidities, and tumor histopathology predict the development of wound complications. An observational study of patients who underwent STS resection and RT was performed. The primary outcome was the occurrence of any wound complication up to four months postoperatively. Significant predictors of wound complications were identified using multivariable logistic regression. Sixty-five patients representing 67 cases of STS were identified. Median age was 59 years (range 22–90) and 34 (52%) patients were female. The rates of major wound complications and any wound complications were 21% and 33%, respectively. After adjusting for radiation timing, diabetes (OR 9.6; 95% CI 1.4–64.8; P = 0.02), grade ≥2 radiation dermatitis (OR 4.8; 95% CI 1.2–19.2; P = 0.03), and the use of 3D conformal RT (OR 4.6; 95% CI 1.1–20.0; P = 0.04) were associated with an increased risk of any wound complication on multivariable analysis. These data suggest that radiation dermatitis and radiation modality are predictors of wound complications in patients with STS.

Highlights

The current standard of care for local control of disease in patients with soft tissue sarcoma (STS) of the extremities and trunk where an adequate margin cannot be obtained with resection alone is surgical resection combined with radiation therapy (RT)
No collinearity was detected and no significant interactions were identified. In this single-center observational study of 67 cases of STS of the extremity and trunk that underwent surgical resection and RT, we found that 3D conformal RT was associated with a greater risk of wound complications relative to more conformal modalities such as intensity-modulated radiation therapy (IMRT) or proton therapy
The use of IMRT or proton therapy was associated with a decreased risk of wound complications relative to the use of 3D conformal RT after adjusting for radiation timing

Summary

Introduction

The current standard of care for local control of disease in patients with soft tissue sarcoma (STS) of the extremities and trunk where an adequate margin cannot be obtained with resection alone is surgical resection combined with radiation therapy (RT). The use of RT is preferred in patients with deep, high-grade, large tumors regardless of the ability to achieve adequate margins. A large randomized control trial found a wound complication rate of 45% in patients with STS of the thigh [4]. Major wound complications encompass a broad array of wounds including those that require reoperation, an invasive procedure without general or regional anesthesia, readmission for wound management, or prolonged deep packing or dressing changes [4].

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