Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma
| Autor: | Matthew C. Biagioli, Kamran Ahmed, John E. Mullinax, Ricardo J. Gonzalez, Douglas Letson, Louis B. Harrison, Jonathan S. Zager, Odion Binitie, Young Chul Kim, Jacob G. Scott, Yazan Abuodeh, Marilyn M. Bui, Amarjit S. Saini, Arash O. Naghavi, Daniel C. Fernandez |
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| Rok vydání: | 2016 |
| Předmět: |
Chronic wound
Male Time Factors medicine.medical_treatment Fibrosarcoma Brachytherapy Soft Tissue Neoplasms Surgical Flaps 030218 nuclear medicine & medical imaging 0302 clinical medicine Aged 80 and over Soft tissue sarcoma Margins of Excision Radiotherapy Dosage Sarcoma Liposarcoma Middle Aged Oncology 030220 oncology & carcinogenesis Female medicine.symptom Adult medicine.medical_specialty Myxosarcoma Article 03 medical and health sciences Young Adult Negative-pressure wound therapy medicine Humans Radiology Nuclear Medicine and imaging Aged Retrospective Studies Wound Healing Wound dehiscence business.industry Retrospective cohort study Extremities Plastic Surgery Procedures medicine.disease Surgery Amputation Multivariate Analysis Radiotherapy Adjuvant Neoplasm Recurrence Local business Negative-Pressure Wound Therapy Follow-Up Studies |
| Zdroj: | Brachytherapy |
| ISSN: | 1873-1449 |
| Popis: | Purpose Prior studies illustrated a reduction in wound complications with the use of staged reconstruction (SR) and negative pressure wound therapy when treating soft tissue sarcoma (STS) with surgical resection followed by high-dose-rate adjuvant brachytherapy. The purpose of this study is to compare the outcomes of SR and immediate reconstruction (IR) brachytherapy in recurrent STS. Methods and Materials A retrospective review of 40 patients with recurrent STS of the local extremity and trunk treated with resection followed by adjuvant brachytherapy alone. Margin status was defined as positive (SM(+)) if there was microscopic involvement (R1) or ≤1 mm margin and negative (SM(−)) if >1 mm margin was obtained. SR and IR were compared regarding toxicity, local control, and limb preservation. Results Median followup was 27 months. When comparing the SR (n = 22) and IR (n = 18) cohorts, there was a significantly lower final SM(+) rate in SR (32% vs. 83%, p < 0.01). A 2-year local control benefit seen with SR (80% vs. 34%; p = 0.012) and a final SM(−) (81% vs. 39%; p = 0.023). SR was associated with less toxicity on multivariate analysis, including a 90% decrease in persistent edema, an 80% decrease in wound dehiscence, and a 94% decrease in nonhealing wounds, when compared to IR. Ten of 31 (32%) extremity cases required eventual amputation from either chronic wound complications (n = 4) or local recurrence (n = 6). SR predicted for a benefit in 2-year limb preservation (88% vs. 50%; p = 0.008). Conclusion In our series, the treatment with SR brachytherapy resulted in less morbidity and an improved final SM(−) rate. This technique translated to an improvement in both local control and limb preservation of recurrent STS. |
| Databáze: | OpenAIRE |
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