Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma

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• 作者：Arash O. Naghavi¹ ; Ricardo J. Gonzalez² ; Jacob G. Scott¹ ; John E. Mullinax² ; Yazan A. Abuodeh¹ ; Youngchul Kim³ ; Odion Binitie² ; Kamran A. Ahmed¹ ; Marilyn M. Bui⁴ ; Amarjit S. Saini¹ ; Jonathan S. Zager⁵ ; Matthew C. Biagioli¹ ; Douglas Letson² ; Louis B. Harrison¹ ; Daniel C. Fernandez¹ ; ^{Daniel.fernandez@moffitt.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Brachytherapy ; Recurrent ; STS ; Sarcoma ; Staged reconstruction ; Delayed reconstruction ; Negative pressure wound therapy ; Vacuum ; Radiation ; Adjuvant
• 刊名：Brachytherapy
• 出版年：2016
• 出版时间：July-August 2016
• 年：2016
• 卷：15
• 期：4
• 页码：495-503
• 全文大小：692 K

文摘

Prior studies illustrated a reduction in wound complications with the use of staged reconstruction (SR) and negative pressure wound therapy when treating soft tissue sarcoma (STS) with surgical resection followed by high-dose-rate adjuvant brachytherapy. The purpose of this study is to compare the outcomes of SR and immediate reconstruction (IR) brachytherapy in recurrent STS.

Methods and Materials

A retrospective review of 40 patients with recurrent STS of the local extremity and trunk treated with resection followed by adjuvant brachytherapy alone. Margin status was defined as positive (SM(+)) if there was microscopic involvement (R1) or ≤1 mm margin and negative (SM(−)) if >1 mm margin was obtained. SR and IR were compared regarding toxicity, local control, and limb preservation.

Results

Median followup was 27 months. When comparing the SR (n = 22) and IR (n = 18) cohorts, there was a significantly lower final SM(+) rate in SR (32% vs. 83%, p < 0.01). A 2-year local control benefit seen with SR (80% vs. 34%; p = 0.012) and a final SM(−) (81% vs. 39%; p = 0.023). SR was associated with less toxicity on multivariate analysis, including a 90% decrease in persistent edema, an 80% decrease in wound dehiscence, and a 94% decrease in nonhealing wounds, when compared to IR. Ten of 31 (32%) extremity cases required eventual amputation from either chronic wound complications (n = 4) or local recurrence (n = 6). SR predicted for a benefit in 2-year limb preservation (88% vs. 50%; p = 0.008).

Conclusion

In our series, the treatment with SR brachytherapy resulted in less morbidity and an improved final SM(−) rate. This technique translated to an improvement in both local control and limb preservation of recurrent STS.