Preoperative RT at a nonsarcoma centre may increase wound complications after resection

In patients with soft tissue sarcoma (STS), preoperative radiation therapy (RT) performed at an academic cancer centre, as opposed to those done at a community centre, results in fewer wound complications following resection, according to a study.

“This may support the recommendation that preoperative RT and resection of STS be performed at an experienced sarcoma centre,” the authors said.

Patients with STS (n=204) were treated with preoperative RT with or without chemotherapy, followed by limb-sparing resection. Of the 204 participants, 105 had preoperative RT performed at an academic sarcoma centre.

Wound complications were characterized as those requiring secondary operations or prolonged wound care for 4 months following surgery. The authors assessed the predictors for wound complication using a Fisher exact test for univariate analysis and logistic regression for multivariate analysis.

Wound complication had an overall incidence of 28.3 percent and was significantly predicted by tumour location and radiation delivered at a community hospital.

When the preoperative RT was performed at an academic cancer centre, the postoperative incidence of wound complication was 21 percent as compared with 39 percent when performed at a community cancer centre (p=0.009).

Multivariate analysis confirmed that both tumour location (odds ratio [OR], 0.13, 95 percent confidence interval [CI], 0.03–0.45; p=0.0012) and RT performed at a community cancer centre (OR, 2.25, 95 percent CI, 1.13–4.48; p=0.02) significantly correlated with postoperative wound complication.

“Preoperative RT followed by wide-local excision with or without chemotherapy is widely accepted as management for STS,” the authors said. “Although studies have demonstrated excellent local control with this technique, there can be significant morbidity with the development of wound complications.”