Abstract
The current paradigm for curative management of soft tissue sarcomas (STS) consists of resection plus local radiation treatment for close or positive margins or high-grade disease. Chemotherapy is added for high-risk patients. Skin reaction tends to be the greatest challenge in the acute management of STS patients during radiation therapy; between 60 and 90 % of them develop some degree of acute radiation dermatitis. Other acute reactions in these patients can include abscess formation, seroma, and wound complications.
Factors reported to impact acute skin reaction include bolus, radiation dose, use of systemic agents, and volume of skin receiving more than 4000 cGy. Preoperative radiation therapy has been associated with a high incidence of wound-healing complications.
Late reactions can include hyperpigmentation, fibrosis, radiation recall, joint stiffness, and progressive lymphedema. The different modalities of radiation treatment confer different risks of late toxicity. Postoperative radiation therapy has been associated with a higher chance of fibrosis.
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References
Roeder F, Lehner B, Schmitt T, Kasper B, Egerer G, Sedlaczek O, et al. Excellent local control with IOERT and postoperative EBRT in high grade extremity sarcoma: results from a subgroup analysis of a prospective trial. BMC Cancer. 2014;14:350. doi:10.1186/1471-2407-14-350.
Lee J, Park YJ, Yang DS, Yoon WS, Lee JA, Rim CH, et al. Treatment outcome of conservative surgery plus postoperative radiotherapy for extremity soft tissue sarcoma. Radiat Oncol J. 2012;30:62–9. doi:10.3857/roj.2012.30.2.62.
American Cancer Society. Cancer Facts and Figures 2015. 2015. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf. Accessed 29 April 2015.
Montero A, Polo A, Hernanz de Lucas R, Sanchez del Campo I, Perez Aguilar D, Fernandez Lizarbe E, et al. Intraoperative radiotherapy (IORT) combined with external beam radiotherapy (EBRT) for the treatment of musculoskeletal tumors. Radiother Oncol. 2011;99:S9. doi: 10.1016/S0167–8140(11)70137–2.
Krasin MJ, Hoth KA, Hua C, Gray JM, Wu S, Xiong X. Incidence and correlates of radiation dermatitis in children and adolescents receiving radiation therapy for the treatment of paediatric sarcomas. Clin Oncol (R Coll Radiol). 2009;21:781–5. doi:10.1016/j.clon.2009.09.022.
Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.
Griffin AM, Euler CI, Sharpe MB, Ferguson PC, Wunder JS, Bell RS, et al. Radiation planning comparison for superficial tissue avoidance in radiotherapy for soft tissue sarcoma of the lower extremity. Int J Radiat Oncol Biol Phys. 2007;67:847–56. doi:10.1016/j.ijrobp.2006.09.048.
Alektiar KM, Hong L, Brennan MF, Della-Biancia C, Singer S. Intensity modulated radiation therapy for primary soft tissue sarcoma of the extremity: preliminary results. Int J Radiat Oncol Biol Phys. 2007;68:458–64. doi:10.1016/j.ijrobp.2006.12.054.
Emory CL, Montgomery CO, Potter BK, Keisch ME, Conway SA. Early complications of high-dose-rate brachytherapy in soft tissue sarcoma: a comparison with traditional external-beam radiotherapy. Clin Orthop Relat Res. 2012;470:751–8. doi:10.1007/s11999-011-2106-5.
Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. In: Cancer Therapy Evaluation Program. National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. 2010. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010–06–14_QuickReference_8.5x11.pdf. Accessed 16 April 2015.
O’Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359:2235–41. doi:10.1016/S0140-6736(02)09292-9.
Davis AM, O’Sullivan B, Turcotte R, Bell R, Catton C, Chabot P, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75:48–53.
Canter RJ, Borys D, Olusanya A, Li CS, Lee LY, Boutin RD, et al. Phase I trial of neoadjuvant conformal radiotherapy plus sorafenib for patients with locally advanced soft tissue sarcoma of the extremity. Ann Surg Oncol. 2014;21:1616–23. doi:10.1245/s10434-014-3543-7.
Niewald M, Fleckenstein J, Licht N, Bleuzen C, Ruebe C. Intraoperative radiotherapy (IORT) combined with external beam radiotherapy (EBRT) for soft-tissue sarcomas—a retrospective evaluation of the Homburg experience in the years 1995–2007. Radiat Oncol. 2009;4:32. doi:10.1186/1748-717X-4-32.
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Paulsson, A.K., Yuen, F., Gottschalk, A. (2016). Sarcoma. In: Fowble, B., Yom, S., Yuen, F., Arron, S. (eds) Skin Care in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-31460-0_13
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DOI: https://doi.org/10.1007/978-3-319-31460-0_13
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