title: Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma.
abstract: OBJECTIVE
  This study compared late radiation morbidity in patients with extremity soft tissue sarcoma randomized to treatment by pre- (50 Gy) or postoperative (66 Gy) radiotherapy in combination with surgery. The morbidities evaluated included fibrosis, joint stiffness and edema at 2 years following treatment. The impact of morbidity on patient function as measured by the Musculoskeletal Tumor Rating Scale (MSTS) and the Toronto Extremity Salvage Score (TESS) was also evaluated.
  
  
  METHODS
  129 patients were evaluated. Toxicity rates were compared by treatment arm using the Fisher's exact test. Function scores by toxicity were analyzed using the Wilcoxon rank sum test. Multivariate logistic regression was used to evaluate the joint effect of treatment arm, field size, and dose on subcutaneous tissue fibrosis, joint stiffness and edema.
  
  
  RESULTS
  27 of 56 patients (48.2%) in the postoperative arm compared to 23 of 73 (31.5%) in the preoperative arm had grade 2 or greater fibrosis (P = 0.07). Although not statistically significant, edema was more frequent in the postoperative arm, 13 of 56 (23.2%) versus 11 of 73 (15.5%) in the preoperative arm, as was joint stiffness, 13 of 56 (23.2%) versus 13 of 73 (17.8%). Patients with significant fibrosis, joint stiffness or edema had significantly lower function scores on both measures (all P-values < 0.01). Field size was predictive of greater rates of fibrosis (P = 0.002) and joint stiffness (P = 0.006) and marginally predictive of edema (P = 0.06).
  
  
  CONCLUSIONS
  Patients treated with postoperative radiotherapy tended to have greater fibrosis. Fibrosis, joint stiffness and edema adversely affect patient function.
authors.affiliation: Toronto Rehabilitation Institute, Ont. M5G 2A2, Canada. davis.aileen@torontorehab.on.ca
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Robert
authors.initials: R
authors.lastname: Turcotte
authors.forename: Robert
authors.initials: R
authors.lastname: Bell
authors.forename: Charles
authors.initials: C
authors.lastname: Catton
authors.forename: Pierre
authors.initials: P
authors.lastname: Chabot
authors.forename: Jay
authors.initials: J
authors.lastname: Wunder
authors.forename: Alex
authors.initials: A
authors.lastname: Hammond
authors.forename: Veronique
authors.initials: V
authors.lastname: Benk
authors.forename: Rita
authors.initials: R
authors.lastname: Kandel
authors.forename: Karen
authors.initials: K
authors.lastname: Goddard
authors.forename: Carolyn
authors.initials: C
authors.lastname: Freeman
authors.forename: Anna
authors.initials: A
authors.lastname: Sadura
authors.forename: Benny
authors.initials: B
authors.lastname: Zee
authors.forename: Andrew
authors.initials: A
authors.lastname: Day
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Tu
authors.forename: Joseph
authors.initials: J
authors.lastname: Pater
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020360:Neoadjuvant Therapy; D017564:Radiation Pneumonitis; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D013997:Time Factors