Preoperative Radiation Performed at a Nonsarcoma Center May Lead to Increased Wound Complications Following Resection in Patients With Soft Tissue Sarcomas.

Ciani Ellison, David M King, John C Neilson, Adam Wooldridge, John A Charlson, Donald A Hackbarth, Candice Johnstone, Meena Bedi
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引用次数: 2

Abstract

Objectives: Preoperative radiation therapy (RT) followed by wide-local excision with or without chemotherapy is widely accepted as management for soft tissue sarcomas (STS). Although studies have demonstrated excellent local control with this technique, there can be significant morbidity with the development of wound complications. It has been shown that sarcoma resections performed at a high-volume center lead to improved survival and functional outcomes. It is unclear, however, if radiation performed in a high-volume center leads to improved outcomes especially related to morbidity. The goal of this study was to determine whether preoperative RT performed at an academic cancer center have lower rates of wound complication compared with RT performed in community cancer centers.

Materials and methods: A total of 204 patients with STS were treated with preoperative RT±chemotherapy followed by limb-sparing resection. Of these, 150 patients had preoperative RT performed at an academic sarcoma center. wound complication were defined as those requiring secondary operations or prolonged wound care for 4 months following surgery. Predictors for wound complication were evaluated using a Fisher exact test for univariate analysis and logistic regression for multivariate analysis.

Results: The overall incidence of wound complication was 28.3%. Significant predictors for wound complication include tumor location and radiation delivered at a community hospital. The postoperative incidence of wound complication was 21% when the preoperative RT was performed at an academic cancer center versus 39% when performed at a community cancer center (P=0.009). On multivariate analysis, both tumor location (P=0.0012, 95% confidence interval: 0.03-0.45, odds ratio: 0.13) and RT performed at a community cancer center (P=0.02, 95% confidence interval: 1.13-4.48, odds ratio: 2.25) remained significant in correlation with postoperative wound complication.

Conclusions: Preoperative RT performed at an academic cancer center led to lower rates of postoperative wound complication. This may support the recommendation that preoperative RT and resection of STS be performed at an experienced sarcoma center.

在非肉瘤中心进行术前放疗可能导致软组织肉瘤患者切除后伤口并发症增加。
目的:术前放疗(RT)加或不加化疗后广泛局部切除被广泛接受为软组织肉瘤(STS)的治疗方法。虽然研究表明该技术具有良好的局部控制性,但随着伤口并发症的发展,可能会出现显著的发病率。研究表明,在大容量中心进行的肉瘤切除术可改善生存率和功能预后。然而,目前尚不清楚在大容量中心进行放射治疗是否会改善预后,特别是与发病率相关的预后。本研究的目的是确定在学术癌症中心进行的术前放疗是否比在社区癌症中心进行的放疗有更低的伤口并发症发生率。材料与方法:204例STS患者术前行放射治疗±化疗后保肢切除。其中,150名患者在学术肉瘤中心进行了术前放疗。伤口并发症定义为术后需要二次手术或延长伤口护理4个月。单因素分析采用Fisher精确检验,多因素分析采用logistic回归,评估伤口并发症的预测因素。结果:伤口并发症总发生率为28.3%。伤口并发症的重要预测因素包括肿瘤位置和在社区医院接受的放疗。术前在学术癌症中心进行RT时,术后伤口并发症发生率为21%,而在社区癌症中心进行RT时为39% (P=0.009)。在多因素分析中,肿瘤位置(P=0.0012, 95%可信区间:0.03-0.45,优势比:0.13)和在社区癌症中心进行的RT (P=0.02, 95%可信区间:1.13-4.48,优势比:2.25)与术后伤口并发症仍有显著相关性。结论:在学术癌症中心进行的术前放疗降低了术后伤口并发症的发生率。这可能支持在有经验的肉瘤中心进行术前放疗和STS切除术的建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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