Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma.
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.
Davis
Aileen M
AM
Toronto Rehabilitation Institute, Ont. M5G 2A2, Canada. davis.aileen@torontorehab.on.ca
O'Sullivan
Brian
B
Turcotte
Robert
R
Bell
Robert
R
Catton
Charles
C
Chabot
Pierre
P
Wunder
Jay
J
Hammond
Alex
A
Benk
Veronique
V
Kandel
Rita
R
Goddard
Karen
K
Freeman
Carolyn
C
Sadura
Anna
A
Zee
Benny
B
Day
Andrew
A
Tu
Dongsheng
D
Pater
Joseph
J
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