Background
In soft tissue sarcomas (STS) radiotherapy (RTx) may be applied pre- or postoperatively with advantages and disadvantages on either side. We examined the effect of preoperative radiation on wound healing in patients with STS of the extremities and the pelvis.
Methods
Between August 2008 and March 2011, 32 patients with an average of 54 years (SD 18.7) and with STS (all Grade 2 or 3) were treated with a planned wide resection after neoadjuvant RTx leaving a rim of uninvolved soft tissue around the tumor. Preoperative RTx was given at an average dose of 51,5 Gy (SD 4.6) and mean follow up was 12.2 months (SD 9.8). The results were compared to a consecutive series of 60 patients treated later on without neoadjuvant RTx.
Results
R0 resection were performed in 31 of 32 patients. Impaired wound healing (IWH) occurred in 19 patients (59%), revision surgery had to be performed in 17 patients (53% of total). Four patients had to undergo 2 or more revisions. One patient had to be amputated and one patient died due to septic complications after revision surgery. IWH was seen more frequently in the lower (18 / 28) than in the upper extremities (1 / 4), yet this was not statistically significant in our series (p = 0.223, Fisher’s exact test). Comorbidities were not found to be of influence. In the control group, revision surgery was necessary in 18% of the patients (p = 0.0006).
Conclusions
Radiotherapy is effective in local tumour control, but causes a high rate of impaired wound healing (59%), if applied prior to surgery. This frequently resulted in one or more revision surgeries delaying the schedule of further therapies. The authors recommend RTx to be applied only in selected cases in a neoadjuvant setting.