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Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma.
- Source :
-
Brachytherapy . Jul2016, Vol. 15 Issue 4, p495-503. 9p. - Publication Year :
- 2016
-
Abstract
- 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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 15384721
- Volume :
- 15
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Brachytherapy
- Publication Type :
- Academic Journal
- Accession number :
- 116221796
- Full Text :
- https://doi.org/10.1016/j.brachy.2016.03.013