Complications of radiation therapy to the hand after soft tissue sarcoma surgery.
OBJECTIVE
Radiation has been shown to improve local control after resection of soft tissue sarcomas. However, it may also result in major complications in the hand, given the compact nature of functional tissues and limited tissue volumes in the hand. The purpose of this investigation was to describe the hand-specific complications of radiation therapy for patients with soft tissue sarcoma of the hand (STSH).


METHODS
We performed a retrospective chart review of 55 consecutive patients with STSH treated by a single surgeon between 1993 and 2006. We identified 26 patients who were treated with external beam radiation, brachytherapy, or both, either preoperatively or postoperatively, and reviewed their clinical course.


RESULTS
After a median follow-up of 7 years, 29 treatment-related complications occurred in 19 patients who had received radiation, whereas 3 of the 29 patients treated with surgery alone developed complications. All patients who received brachytherapy and 14 of the 21 treated with external beam radiation alone developed complications. There were 5 early minor, 2 early major, 3 late minor, and 19 late major complications.


CONCLUSIONS
Patients with STSH who underwent radiation therapy had a high rate of complications. The complication rate in our series was higher in patients who had brachytherapy catheters placed adjacent to finger joints. A better understanding of predictors of complications will help to determine the optimal timing and type of radiation therapy to treat patients with STSH.


METHODS
Therapeutic IV.
Department of Hand and Reconstructive Microsurgery, National University Hospital, 1E, Kent Ridge Road, NUHS Tower Block, Level 11, Singapore 119228.
Rachel S
RS
Rohde
Mark E
ME
Puhaindran
Carol D
CD
Morris
Kaled M
KM
Alektiar
Karen D
KD
Schupak
John H
JH
Healey
Edward A
EA
Athanasian
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002648:Child; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006225:Hand / Q000528:radiation effects* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019637:Orthopedic Procedures / Q000379:methods; D010025:Osteoradionecrosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011182:Postoperative Care; D011300:Preoperative Care / Q000379:methods; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult