Wound Healing Complication in Radio-Treated Limb Soft Tissue Sarcoma Patients: A Single Referral Centre Experience

Abstract

Radiotherapy is recommended for G2-G3 large soft tissue sarcoma in association with radical wide excision in order to improve the local control of disease, but side-effects may develop early after radiation invalidating wound healing. We retrospective evaluated short- and long-term clinically relevant outcomes after surgery of limb STS with or without radiotherapy. All 243 patients with limb STS treated at the Veneto Institute Oncology (Padua, Italy) in 2015–2022 were retrospectively included. Outcome measures were short- and long-term wound complications, length of hospital stay and outpatient care time. Multivariable analyses were performed using linear regression models and logistic regression models. Overall, 87 patients received neoadjuvant radiotherapy, 64 received adjuvant radiotherapy and 92 underwent surgery alone. At short-term, multivariable analysis identified neoadjuvant radiotherapy as a risk factor for prolonged length of hospital stay (MD 6.4 days, 95%CI 3.9 to 9.0 days) and short-term wound complications (OR 3.45, 95%CI 1.82 to 6.62). At long-term, neoadjuvant radiotherapy was a risk factor for long-term wound complications (OR 4.87, 95%CI 2.48 to 9.84), and longer outpatient care time (MD 83 days, 95%CI 41 to 126 days); similarly, adjuvant radiotherapy was also a risk factor for long-term complications (OR 5.20, 95%CI 2.57 to 10.95) and longer outpatient care time (MD 62 days, 95%CI 19 to 106 days). Radiotherapy in limb STS was associated with impaired short- and long-term clinically relevant outcomes, potentially affecting quality of life and healthcare costs. Balancing with its well-known oncological benefits, new clinical strategies are needed to contain cutaneous radiogenic side effects. The use of negative pressure therapy can play a key role in the prevention of wound complications in oncological patients.