Postoperative complications and oncologic outcomes after multimodal therapy of localized high risk soft tissue sarcoma

Radiation Oncology

Research

Ruth Ladurner¹  Adrien Daigeler²  Jonas Kolbenschlag²  Alexander Golf³  Saskia Sachsenmaier⁴  Frank Paulsen⁵  Vlatko Potkrajcic⁵  Cihan Gani⁵  Franziska Eckert⁶  Daniel Zips⁷ 

[1] Department of General, Visceral and Transplant Surgery, Eberhard-Karls-University Tuebingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany;Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik, Eberhard-Karls-University Tuebingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany;Department of Internal Medicine, Medical Oncology and Pulmonology, Eberhard-Karls-University Tuebingen, Otfried-Müller-Straße 14, 72076, Tuebingen, Germany;Department of Orthopaedic Surgery, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany;Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany;Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany;Department of Radiation Oncology, Comprehensive Cancer Center, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria;Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany;German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK) Partnersite Tuebingen, Heidelberg, Germany;Department of Radiation Oncology and Radiotherapy, Charité University Hospital, Charitépl. 1, 10117, Berlin, Germany;

关键词: Radiotherapy;    Soft tissue sarcoma;    Multimodal therapy;    Postoperative complications;   

DOI  :  10.1186/s13014-022-02166-4

 received in 2022-07-26, accepted in 2022-11-21,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundStandard therapy for localized high-risk soft tissue sarcoma includes surgical resection and neoadjuvant or adjuvant radiation therapy (± chemotherapy and locoregional hyperthermia). No difference in oncologic outcomes for patients treated with neoadjuvant and adjuvant radiation therapy was reported, whereas side effect profiles differ. The aim of this analysis was to analyse oncologic outcomes and postoperative complications in patients treated with multimodal treatment.MethodsOncologic outcomes and major wound complications (MWC, subclassified as wound healing disorder, infection, abscess, fistula, seroma and hematoma) were evaluated in 74 patients with localized high-risk soft tissue sarcoma of extremities and trunk undergoing multimodal treatment, and also separately for the subgroup of lower extremity tumors. Clinical factors and treatment modalities (especially neoadjuvant vs. adjuvant radiotherapy) were evaluated regarding their prognostic value and impact on postoperative wound complications.ResultsOncologic outcomes were dependent on number of high risk features (tumor size, depth to superficial fascia and grading), but not on therapy sequencing (however with higher risk patients in the neoadjuvant group). Different risk factors influenced different subclasses of wound healing complications. Slightly higher MWC-rates were observed in patients treated with neoadjuvant therapy, compared to adjuvant radiotherapy, although only with a trend to statistical significance (31.8% vs. 13.3%, p = 0.059). However, except for wound infections, no significant difference for other subclasses of postoperative complications was observed between neoadjuvant and adjuvant therapy. Diabetes was confirmed as a major risk factor for immune-related wound complications.ConclusionRates of major wound complications in this cohort are comparable to published data, higher rates of wound infections were observed after neoadjuvant radiotherapy. Tumor localization, patient age and diabetes seem to be major risk factors. The number of risk factors for high risk soft tissue sarcoma seem to influence DMFS. Neoadjuvant treatment increases the risk only for wound infection treated with oral or intravenous antibiotic therapy and appears to be a safe option at an experienced tertiary center in absence of other risk factors.

【 授权许可】

CC BY   
© The Author(s) 2022

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