BACKGROUND. Correlations between various patient, tumor, and treatment characteristics and complications in patients undergoing combined modality treatment for primary lower extremity soft‐tissue sarcomas were investigated. METHODS. Using the M. D. Anderson Radiation Oncology database, the records of the subset of patients treated with combined radiation and limb‐sparing surgery for primary lower extremity soft‐tissue sarcomas were retrospectively reviewed from the years 1960 to 2003. RESULTS. In all, 412 patients were identified. With a median follow‐up of 9.3 years, there were a total of 113 (27%) acute wound complications and 41 (13% at 20 years) chronic radiation‐related limb complications. Preoperative radiation and tumor sizes >5 cm were associated with an increased risk of acute wound complications (34% preoperative vs. 16% postoperative, P < .001; and 31% >5 cm vs. 17% ≤5 cm, P = .005). At 20 years the radiation‐related complication rate was higher in patients with a groin or thigh tumor location (16% vs. 4% other; P = .008), prior acute wound complications (20% vs. 10% no surgical complication), and a radiation dose ≥60 grays (Gy) (18% vs. 9% for dose < 60 Gy; P = .04). Five fractures occurred, resulting in a crude overall fracture rate of 1.2%. CONCLUSIONS. Patients treated with preoperative radiation for larger tumors are more likely to have acute surgical wound complications. Acute wound complications followed by postoperative radiation are associated with chronic radiation‐related limb problems, as are higher radiation dose and proximal tumor location. The fracture rate is so low that prophylactic fixation is not warranted. Cancer 2006.
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BACKGROUND. Correlations between various patient, tumor, and treatment characteristics and complications in patients undergoing combined modality treatment for primary lower extremity soft‐tissue sarcomas were investigated. METHODS. Using the M. D. Anderson Radiation Oncology database, the records of the subset of patients treated with combined radiation and limb‐sparing surgery for primary lower extremity soft‐tissue sarcomas were retrospectively reviewed from the years 1960 to 2003. RESULTS. In all, 412 patients were identified. With a median follow‐up of 9.3 years, there were a total of 113 (27%) acute wound complications and 41 (13% at 20 years) chronic radiation‐related limb complications. Preoperative radiation and tumor sizes >5 cm were associated with an increased risk of acute wound complications (34% preoperative vs. 16% postoperative, P < .001; and 31% >5 cm vs. 17% ≤5 cm, P = .005). At 20 years the radiation‐related complication rate was higher in patients with a groin or thigh tumor location (16% vs. 4% other; P = .008), prior acute wound complications (20% vs. 10% no surgical complication), and a radiation dose ≥60 grays (Gy) (18% vs. 9% for dose < 60 Gy; P = .04). Five fractures occurred, resulting in a crude overall fracture rate of 1.2%. CONCLUSIONS. Patients treated with preoperative radiation for larger tumors are more likely to have acute surgical wound complications. Acute wound complications followed by postoperative radiation are associated with chronic radiation‐related limb problems, as are higher radiation dose and proximal tumor location. The fracture rate is so low that prophylactic fixation is not warranted. Cancer 2006.
Copyright remains with the authors and publisher.