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Annals of Surgical Oncology

, Volume 20, Issue 5, pp 1494–1499 | Cite as

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

  • Elizabeth H. BaldiniEmail author
  • Michelle R. Lapidus
  • Qian Wang
  • Judith Manola
  • Dennis P. Orgill
  • Bohdan Pomahac
  • Karen J. Marcus
  • Monica M. Bertagnolli
  • Phillip M. Devlin
  • Suzanne George
  • John Abraham
  • Marco L. Ferrone
  • John E. Ready
  • Chandrajit P. Raut
Bone and Soft Tissue Sarcomas

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.

Keywords

Skin Surface Postoperative Radiation Therapy Intensity Modulate Radiation Therapy Free Flap Preoperative Radiation Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors thank Barbara Silver for her editorial assistance.

Conflict of interest

None.

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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Elizabeth H. Baldini
    • 1
    • 5
    Email author
  • Michelle R. Lapidus
    • 2
    • 5
  • Qian Wang
    • 6
  • Judith Manola
    • 7
  • Dennis P. Orgill
    • 3
  • Bohdan Pomahac
    • 3
  • Karen J. Marcus
    • 1
    • 5
  • Monica M. Bertagnolli
    • 2
    • 5
  • Phillip M. Devlin
    • 1
    • 5
  • Suzanne George
    • 5
    • 9
  • John Abraham
    • 8
  • Marco L. Ferrone
    • 4
    • 5
  • John E. Ready
    • 4
    • 5
  • Chandrajit P. Raut
    • 2
    • 5
  1. 1.Department of Radiation OncologyBrigham and Women’s HospitalBostonUSA
  2. 2.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Plastic SurgeryBrigham and Women’s HospitalBostonUSA
  4. 4.Department of Orthopedic SurgeryBrigham and Women’s HospitalBostonUSA
  5. 5.Center for Sarcoma and Bone OncologyDana-Farber Cancer InstituteBostonUSA
  6. 6.Beijing Novartis Pharma Co. Ltd.BeijingChina
  7. 7.Department of Biostatistics and Computational BiologyDana-Farber Cancer InstituteBostonUSA
  8. 8.Department of Orthopedic Surgery, Rothman InstituteThomas Jefferson UniversityPhiladelphiaUSA
  9. 9.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA

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