scholarly journals Incidence and Severity of Lymphoedema following Limb Salvage of Extremity Soft Tissue Sarcoma

Sarcoma ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Daniel Friedmann ◽  
Jay S. Wunder ◽  
Peter Ferguson ◽  
Brian O'Sullivan ◽  
David Roberge ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Soft Tissue Sarcomas ◽  
Treatment Modalities ◽  
Adjuvant Radiation ◽  
Tumor Characteristics ◽  
Msts Score ◽  
Extremity Soft Tissue Sarcoma ◽  
Associated Risk Factors

Background and Purpose. Lymphoedema is a serious complication following limb salvage for extremity soft tissue sarcomas (STSs) for which little is known. We aimed to evaluate its incidence, its, severity and its associated risk factors.Material and Method. Patient and tumor characteristics, treatment modalities and complications and functional outcomes (MSTS 1987, TESS), and lymphoedema severity (Stern) were all collected from prospective databases. Charts were retrospectively abstracted for BMI and comorbidities.Results. There were 289 patients (158 males). Mean age was 53 (16–88). Followup ranged between 12 and 60 months with an average of 35 and a median of 36 months. Mean BMI was 27.4 (15.8–52.1). 72% had lower extremity tumors and 38% upper extremity. Mean tumor size was 8.1 cm (1.0–35.6 cm). 27% had no adjuvant radiation, 62% had 50 Gy, and 11% received 66 Gy. The incidence of lymphoedema was 28.8% (206 none, 58 mild, 22 moderate, 3 severe, and 0 very severe). Mean MSTS score was 32 (11–35) and TESS was 89.4 (32.4–100). Radiation dose was significantly correlated with tumorsize>5 cm (P=0.0001) and TESS score (P=0.001), but not MSTS score (P=0.090). Only tumorsize>5 cm and depth were found to be independent predictors of significant lymphoedema.Conclusion. Nine percent of STS patients in our cohort developed significant (grade≥2) lymphoedema. Tumorsize>5 cm and deep tumors were associated with an increased occurrence of lymphoedema but not radiation dosage.

scholarly journals Postoperative Wound Complications in Fungating Extremity Soft Tissue Sarcomas

2019 ◽  
pp. 273-279
Author(s):  
Blakely AM ◽  
Chow W ◽  
Sampath S ◽  
Femino JD ◽  
Lozano-Calderon S ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Excision ◽  
Soft Tissue Sarcomas ◽  
Wound Complication ◽  
Wound Complications ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Pleomorphic Sarcoma ◽  
Extremity Soft Tissue Sarcoma ◽  
Clinically Significant

Background: Among deep extremity soft tissue sarcomas, skin ulceration is infrequent. Fungating sarcomas may lead to infection or clinically significant bleeding. Data regarding management of ulcerating sarcomas is lacking. We sought to evaluate the outcomes of different treatments for these tumors.Patients and methods: A retrospective review of patients treated at two sarcoma referral centers with histologically confirmed extremity soft tissue sarcoma was performed from 2000-2018. Patient demographics, clinicopathologic, and treatment factors were analyzed in terms of method of resection, receipt of radiation, and wound complications.Results: Overall, 22 patients had fungating lesions. Most patients were male with tumors of the distal extremity.Median tumor size was 8 cm. Half had undifferentiated pleomorphic sarcoma histology, followed by myxofibrosarcoma (n=5), leiomyosarcoma (n=3), or other (n=3). Fifteen patients (68%) underwent limb-preserving resection, of which 7 underwent adjuvant radiation. Six patients (27%) developed wound complications, which occurred equally between amputation versus local excision (p = 0.93). Among local excision patients, one who received adjuvant radiation developed a wound complication (14%), which was not significantly different from those who did not undergo radiation (n=3 of 8, 38%; p = 0.31).Conclusions: Similar rates of wound complications were seen between amputation and limb-preserving groups.Among patients who underwent local excision, the administration of adjuvant radiation therapy did not significantly increase wound complication rates.

Flap Reconstruction of Sarcoma Defects in the Setting of Neoadjuvant and Adjuvant Radiation

2018 ◽  
Vol 35 (04) ◽  
pp. 287-293 ◽  
Author(s):  
Rohini Kadle ◽  
Catherine Motosko ◽  
George Zakhem ◽  
John Stranix ◽  
Timothy Rapp ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Radiation Treatment ◽  
Soft Tissue Sarcomas ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Fasciocutaneous Flaps ◽  
Musculoskeletal Tumor Society

Background Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds. Methods A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016. Results Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps. Mean defect size, radiation treatment, and follow-up length were similar between groups. More often, muscle-based flaps were performed in younger patients and in the lower extremity. Seventeen flaps were exposed to neoadjuvant radiation, 12 to adjuvant radiation, 5 to both, and 17 to no radiation therapy. Regardless of radiation treatment, complication rates were comparable, with 28% in fasciocutaneous and 31% in muscle-based groups (p < 0.775). Muscle-based flaps performed within 6 weeks of undergoing radiotherapy were less likely to result in complications than those performed after greater than 6 weeks (p < 0.048). At time of follow-up, Musculoskeletal Tumor Society scores for fasciocutaneous and muscle-based reconstructions, with or without radiation, showed no significant differences between groups (mean [SD]: 91% [8%] vs. 89% [13%]). Conclusion The similar complication rates and functional outcomes in this study support the safety and efficacy of both fasciocutaneous flaps and muscle-based flaps in reconstructing limb-sparing sarcoma resection defects, with or without radiotherapy.

Non Conventional Fractionation in Radiotherapy of the Musculo-Skeletal Sarcomas

1998 ◽  
Vol 84 (2) ◽  
pp. 167-170 ◽  
Author(s):  
Enza Barbieri ◽  
Giovanni Frezza ◽  
Ombretta Martelli ◽  
Stefano Neri ◽  
Mario Mercuri ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Late Effects ◽  
Surgical Complications ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Young Patients ◽  
Soft Tissue Sarcomas ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Bulky Disease

In 1989 we started an accelerated hyperfractionated schedule of radiotherapy (two 1.6 Gy daily fractions) in standard risk localized Ewing's sarcoma of bone, with the aim at reducing late effects in young patients and at improving disease control through a better integration of treatment modalities. From 1991, the same schedule was used in preoperative radiotherapy of adult soft tissue sarcomas of the extremities: the main purpose was to reduce the time to surgery and to evaluate surgical complications in comparison with a previous experience of hypofractionated radiotherapy (one 3 Gy daily fraction). From 1991 to 1997, 76 patients with Ewing's sarcoma and 24 patients with soft tissue sarcoma were treated at our Institution. Results and complication rates are analyzed in comparison with historical data. In Ewing's sarcoma, a correct evaluation of improvement in local control was difficult because of changing treatment policy (bulky disease was not included in the present series). Late effects, as evaluated in patients with a minimum follow-up of 3 years, occurred with similar incidence, but at higher total dose levels in patients treated with accelerated hyperfractionation. In patients with soft tissue sarcomas, incidence of surgical complications is reduced as compared to historical experience. Major problems of wound healing were seen in association with intraoperative brachitherapy boost.

scholarly journals Feasibility of limb salvage and survival in soft tissue sarcomas

Cancer ◽  
1986 ◽  
Vol 57 (3) ◽  
pp. 484-491 ◽  
Author(s):  
Constantine P. Karakousis ◽  
Lawrence J. Emrich ◽  
Uma Rao ◽  
Ramachandra M. Krishnamsetty
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas

scholarly journals Limb salvage for soft-tissue sarcomas of the foot and ankle

2010 ◽  
Vol 92-B (3) ◽  
pp. 424-429 ◽  
Author(s):  
G. L. Cribb ◽  
S. C. S. Loo ◽  
I. Dickinson
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas ◽  
Foot And Ankle

scholarly journals Limb Salvage from a Multidisciplinary Treatment Approach for Skeletal and Soft Tissue Sarcomas of the Extremity

1976 ◽  
Vol 184 (3) ◽  
pp. 268-278 ◽  
Author(s):  
DONALD L. MORTON ◽  
FREDERICK R. EILBER ◽  
COURTNEY M. TOWNSEND ◽  
TODD T. GRANT ◽  
JOSEPH MIRRA ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Treatment Approach ◽  
Multidisciplinary Treatment ◽  
Soft Tissue Sarcomas
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