1203 - Wound Complication Risk Following Preoperative Hypofractionated Radiotherapy: Secondary Analysis of a Prospective Phase II Clinical Trial in Soft Tissue Sarcomas
Presenter(s)
B. A. Crosswhite1, J. Burns1, B. S. Bingham2, J. Halpern3, H. Schwartz3, R. M. Whitaker4, Z. A. Kohutek1, A. Shinde1, D. K. Gaines1, J. Lawrenz3, E. T. Shinohara1, and L. Luo1; 1Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, 2Intermountain Health, St. George, UT, 3Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 4Tennessee Oncology, Nashville, TN
Purpose/Objective(s): Neoadjuvant hypofractionated radiotherapy (RT) followed by surgical resection is increasingly utilized in the treatment of soft tissue sarcomas. However, the risk of wound complication (WC) after surgery remains poorly understood.
Materials/Methods: Wound complication data were collected from a prospective phase II trial on the safety and feasibility of preoperative hypofractionated RT followed by surgical resection. WC was defined as wound management requiring a second procedure, readmission for wound care, dehiscence of at least 2cm in length, revision of graft, or requirement of wet dressing for >4 weeks. Multivariable statical analysis was used to determine clinical and dosimetric factors contributing to increased WC rates.
Results: Twenty-one patients with extremity or trunk soft tissue sarcomas were enrolled and treated with preoperative RT to a dose of 30-40 Gy in 5 fractions. WC occurred in 11 of 21 patients (52.4%). Superficial tumors had a significantly higher WC rate compared to tumors located deep to the fascia (100% vs. 43.8%, p = 0.0451). Tumor location, surgical timing, histologic subtype, stage, size, grade, and provider-related factors were not predictive of WC (Table 1). Dosimetric comparison of skin in patients with vs without WC including D100cc, D3cc, Dmax, Dmean, Dmin, V10Gy, V20Gy, and V30Gy were not significantly different.
Conclusion: In this prospective phase II clinical trial evaluating hypofractionated preoperative RT for soft tissue sarcomas, WC occurred in over half of treated patients. Secondary analysis identified tumor depth as a significant factor associated with WC, with superficial tumors demonstrating a markedly higher WC rate compared with deep tumors.
| Table 1 | AE | No AE | Total | P value |
| Total | 11 | 10 | 21 | |
| Tumor Depth | | | | 0.045a |
| superficial | 5 | 0 | 5 | |
| deep | 7 | 9 | 16 | |
| Surgery | | | | 0.338a |
| Immediate (3-7 days post RT) | 4 | 1 | 5 | |
| Delayed (4-6 weeks post RT) | 8 | 8 | 16 | |
| Presenting Stage | | | | 0.343b |
| IB | 2 | 1 | 3 | |
| IIIA | 6 | 2 | 8 | |
| IIIB | 3 | 5 | 8 | |
| IVA | 0 | 1 | 1 | |
| IVB | 1 | 0 | 1 | |
| Tumor Size (binary) | | | | 0.387a |
| >8.5cm | 5 | 5 | 10 | |
| < 8.5cm | 7 | 4 | 11 | |
| Peripheral Vascular Disease | 0 | 1 | 1 | 0.429a |
| Tumor Location | | | | 0.475b |
| Trunk | 1 | 1 | 2 | 1.00 |
| Upper Extremity | 0 | 1 | 1 | 0.88 |
| Lower Extremity | 11 | 8 | 19 | 0.79 |
| Tumor Grade | | | | 0.530b |
| Low | 0 | 1 | 1 | |
| Intermediate | 2 | 3 | 5 | |
| High | 8 | 4 | 12 | |
| Unknown | 2 | 1 | 3 | |
| Extremity | | | | 0.606b |
| Anterior Arm | 0 | 1 | 1 | 0.88 |
| Anterior Leg | 2 | 0 | 2 | 0.59 |
| Adductor | 2 | 2 | 4 | 1.00 |
| Quadriceps | 2 | 1 | 3 | 1.00 |
| Posterior Leg | 3 | 1 | 4 | 0.81 |
| Inguinal | 0 | 1 | 1 | 0.88 |
| Hamstring | 1 | 2 | 3 | 0.79 |
| Buttock | 1 | 0 | 1 | 1.00 |
| Chest Wall | 1 | 1 | 2 | 1.00 |
| Smoking history | 3 | 3 | 6 | 0.916b |
| Diabetes | 2 | 2 | 4 | 1.000a |
| Metastasis at Presentation | 1 | 1 | 2 | 1.000a |
| NOTE: Statistical analysis was performed with either Fisher's exact test or chi-square test | ||||
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