title: Complications of combined modality treatment of primary lower extremity soft-tissue sarcomas.
abstract: BACKGROUND
  Correlations between various patient, tumor, and treatment characteristics and complications in patients undergoing combined modality treatment for primary lower extremity soft-tissue sarcomas were investigated.
  
  
  METHODS
  Using the M. D. Anderson Radiation Oncology database, the records of the subset of patients treated with combined radiation and limb-sparing surgery for primary lower extremity soft-tissue sarcomas were retrospectively reviewed from the years 1960 to 2003.
  
  
  RESULTS
  In all, 412 patients were identified. With a median follow-up of 9.3 years, there were a total of 113 (27%) acute wound complications and 41 (13% at 20 years) chronic radiation-related limb complications. Preoperative radiation and tumor sizes >5 cm were associated with an increased risk of acute wound complications (34% preoperative vs. 16% postoperative, P < .001; and 31% >5 cm vs. 17% < or =5 cm, P = .005). At 20 years the radiation-related complication rate was higher in patients with a groin or thigh tumor location (16% vs. 4% other; P = .008), prior acute wound complications (20% vs. 10% no surgical complication), and a radiation dose > or =60 grays (Gy) (18% vs. 9% for dose < 60 Gy; P = .04). Five fractures occurred, resulting in a crude overall fracture rate of 1.2%.
  
  
  CONCLUSIONS
  Patients treated with preoperative radiation for larger tumors are more likely to have acute surgical wound complications. Acute wound complications followed by postoperative radiation are associated with chronic radiation-related limb problems, as are higher radiation dose and proximal tumor location. The fracture rate is so low that prophylactic fixation is not warranted.
authors.affiliation: Department of Orthopaedic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230, USA. cpcannon@mdanderson.org
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Ballo
authors.forename: Gunar K
authors.initials: GK
authors.lastname: Zagars
authors.forename: Attiqa N
authors.initials: AN
authors.lastname: Mirza
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Lin
authors.forename: Valerae O
authors.initials: VO
authors.lastname: Lewis
authors.forename: Alan W
authors.initials: AW
authors.lastname: Yasko
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003131:Combined Modality Therapy / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000528:radiation effects / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications / Q000453:epidemiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012509:Sarcoma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014945:Wound Healing / Q000528:radiation effects