This multicenter RCT randomized 190 adults with extremity soft-tissue sarcoma to preoperative (50 Gy/25 fractions) versus postoperative radiotherapy (66 Gy/33 fractions). The primary question: does radiation timing affect major wound complication rates within 120 days of surgery? Stratification was by tumor size (≤10 cm vs >10 cm).
Radiation timing in extremity sarcoma is a genuine trade-off, not a clear winner. Before this trial, the wound complication excess with preoperative radiation was documented only in retrospective series prone to selection bias — surgeons tended to choose preoperative radiation for more advanced lesions, inflating apparent complication rates.
This RCT quantified the trade-off with level I evidence: preoperative radiation increases wound complication risk by 18% in absolute terms, but spares patients from larger fields, higher doses, and nearly double the rate of severe acute skin toxicity.
When counseling a patient on radiation timing, location matters as much as anything else. Lower leg tumors carry a 38% wound complication rate with preoperative radiation vs 5% postoperative. That gap should drive decision-making. Upper extremity tumors show minimal difference and may actually favor preoperative radiation to protect adjacent structures like the brachial plexus.
The practical framework this paper established: individualize based on grade, size, and anatomical site. For a large, high-grade thigh or lower leg sarcoma in a patient with healing risk factors (diabetes, smoking), postoperative radiation avoids a wound disaster. For an upper arm lesion where field size and dose to adjacent neurovascular structures are the concern, preoperative radiation is the better trade.
Preoperative versus Postoperative Radiotherapy in Soft-Tissue Sarcoma of the Limbs: a Randomised Trial.
Radiological Assessment of Osteo-Arthrosis.
Mesenchymal Stem Cells.
Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty. an End-Result Study Using a New Method of Result Evaluation.
Bone: Formation by Autoinduction.
Treatment of Deep Cartilage Defects in the Knee with Autologous Chondrocyte Transplantation.
Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity
Osteoclast Differentiation Factor Is a Ligand for Osteoprotegerin/osteoclastogenesis-Inhibitory Factor and Is Identical to Trance/rankl.
Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. Vigor Study Group.
Magnetic Resonance Classification of Lumbar Intervertebral Disc Degeneration.
Novel Regulators of Bone Formation: Molecular Clones and Activities.
The Diagnosis of Osteoporosis.
"modes of Failure" of Cemented Stem-Type Femoral Components: a Radiographic Analysis of Loosening.
Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: a Prospective Study.
Femoroacetabular Impingement: a Cause for Osteoarthritis of the Hip.
Prevention of Infection in the Treatment of One Thousand and Twenty-Five Open Fractures of Long Bones: Retrospective and Prospective Analyses.
The Variation in Isometric Tension with Sarcomere Length in Vertebrate Muscle Fibres.
Osteoarthritis: a Disease of the Joint as an Organ.
Radiological Demarcation of Cemented Sockets in Total Hip Replacement.
Ectopic Ossification Following Total Hip Replacement. Incidence and a Method of Classification.
The Operation of the Century: Total Hip Replacement.
Fatty Muscle Degeneration in Cuff Ruptures. Pre- and Postoperative Evaluation by CT Scan.
Osseointegrated Titanium Implants. Requirements for Ensuring a Long-Lasting, Direct Bone-To-Implant Anchorage in Man.
The Etiology of Chondromalacia Patellae.
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The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries.
Dislocations after Total Hip-Replacement Arthroplasties.
Patient Satisfaction after Total Knee Arthroplasty: Who Is Satisfied and Who Is Not?
Problems in the Management of Type III (severe) Open Fractures: a New Classification of Type III Open Fractures.
The Value of Postural Reduction in the Initial Management of Closed Injuries of the Spine with Paraplegia and Tetraplegia. I.
Vacuum-Assisted Closure: a New Method for Wound Control and Treatment: Animal Studies and Basic Foundation.
A System for the Functional Evaluation of Reconstructive Procedures after Surgical Treatment of Tumors of the Musculoskeletal System.
A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement.
The Outcome and Repair Integrity of Completely Arthroscopically Repaired Large and Massive Rotator Cuff Tears.
The Tension-Stress Effect on the Genesis and Growth of Tissues. Part I. the Influence of Stability of Fixation and Soft-Tissue Preservation.
A System for the Surgical Staging of Musculoskeletal Sarcoma.
A Comprehensive Classification of Thoracic and Lumbar InjuriesCitation only
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Hip Morphology Influences the Pattern of Damage to the Acetabular Cartilage: Femoroacetabular Impingement as a Cause of Early Osteoarthritis of the Hip.
Porosity of 3D Biomaterial Scaffolds and Osteogenesis.
A Report: the Definition and Classification of Cerebral Palsy April 2006.
Clinician's Guide to Prevention and Treatment of Osteoporosis.
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Radiation Exposure from CT Scans in Childhood and Subsequent Risk of Leukaemia and Brain Tumours: a Retrospective Cohort Study.
Epidemiology of Adult Fractures: a Review.
Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.
Osteoblastic Cells Regulate the Haematopoietic Stem Cell Niche.
A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee.
Consensus Statement on Concussion in Sport-The 5th International Conference on Concussion in Sport Held in Berlin, October 2016.
Oarsi Guidelines for the Non-Surgical Management of Knee Osteoarthritis.
Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050.
Metastasis to Bone: Causes, Consequences and Therapeutic Opportunities.
Role of Proinflammatory Cytokines in the Pathophysiology of Osteoarthritis.
The Basic Science of Articular Cartilage: Structure, Composition, and Function.
Osteoporosis: Now and the Future.
Clinical Features of Metastatic Bone Disease and Risk of Skeletal Morbidity.
Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs. a 1:1:2 Ratio and Mortality in Patients with Severe Trauma: the Proppr Randomized Clinical Trial
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Peek Biomaterials in Trauma, Orthopedic, and Spinal Implants.
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Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America.
The Amazing Osteocyte.
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The 2018 Definition of Periprosthetic Hip and Knee Infection: an Evidence-Based and Validated Criteria.
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Prevalence of Muscular Dystrophies: a Systematic Literature Review.
Mechanisms of Bone Metastasis.
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Diagnosis and Treatment of Hip and Knee Osteoarthritis
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This multicenter RCT randomized 190 adults with extremity soft-tissue sarcoma to preoperative (50 Gy/25 fractions) versus postoperative radiotherapy (66 Gy/33 fractions). The primary question: does radiation timing affect major wound complication rates within 120 days of surgery? Stratification was by tumor size (≤10 cm vs >10 cm).
Radiation timing in extremity sarcoma is a genuine trade-off, not a clear winner. Before this trial, the wound complication excess with preoperative radiation was documented only in retrospective series prone to selection bias — surgeons tended to choose preoperative radiation for more advanced lesions, inflating apparent complication rates.
This RCT quantified the trade-off with level I evidence: preoperative radiation increases wound complication risk by 18% in absolute terms, but spares patients from larger fields, higher doses, and nearly double the rate of severe acute skin toxicity.
When counseling a patient on radiation timing, location matters as much as anything else. Lower leg tumors carry a 38% wound complication rate with preoperative radiation vs 5% postoperative. That gap should drive decision-making. Upper extremity tumors show minimal difference and may actually favor preoperative radiation to protect adjacent structures like the brachial plexus.
The practical framework this paper established: individualize based on grade, size, and anatomical site. For a large, high-grade thigh or lower leg sarcoma in a patient with healing risk factors (diabetes, smoking), postoperative radiation avoids a wound disaster. For an upper arm lesion where field size and dose to adjacent neurovascular structures are the concern, preoperative radiation is the better trade.