title: Predictors for major wound complications following preoperative radiotherapy and surgery for soft-tissue sarcoma of the extremities and trunk: importance of tumor proximity to skin surface.
abstract: OBJECTIVE
  Preoperative and postoperative RT for the treatment of high-grade soft-tissue sarcoma result in similar local control and overall survival rates, but morbidities differ. Postoperative RT is associated with a higher rate of long-term fibrosis, edema, and joint stiffness. Preoperative RT is associated with higher rates of wound complications. It is important to identify predictors for major wound complications (MWC) and to develop strategies to minimize this outcome. We reviewed our experience to determine predictors for MWC following preoperative radiotherapy (RT) and surgery for soft-tissue sarcoma.
  
  
  METHODS
  Between January 2006 and May 2011, 103 patients with soft-tissue sarcoma of the extremities and trunk were treated with preoperative RT followed by surgery. MWCs were defined as those requiring operative or prolonged nonoperative management. Fisher's exact test was used to compare rates. Logistic regression was used for multivariable analysis of factors potentially associated with MWCs.
  
  
  RESULTS
  Median tumor size was 8.4 cm (range 2-25). All patients had wide or radical resections. Wound closures were primary in 70 %, a vascularized flap in 27 %, and split-thickness skin graft (STSG) in 3 %. There were 36 MWCs (35 %). Significant predictors for MWCs on univariate analysis included diabetes, tumors >10 cm, tumors <3 mm from skin surface, and vascularized flap/STSG closure. The same four variables were significant predictors on multivariable analysis.
  
  
  CONCLUSIONS
  MWCs following preoperative RT and surgery were common. Tumor proximity to skin surface <3 mm is a previously unreported independent predictor, and further strategies to minimize wound complications are needed.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA. ebaldini@partners.org
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Baldini
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Lapidus
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Judith
authors.initials: J
authors.lastname: Manola
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Marcus
authors.forename: Monica M
authors.initials: MM
authors.lastname: Bertagnolli
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Devlin
authors.forename: Suzanne
authors.initials: S
authors.lastname: George
authors.forename: John
authors.initials: J
authors.lastname: Abraham
authors.forename: Marco L
authors.initials: ML
authors.lastname: Ferrone
authors.forename: John E
authors.initials: JE
authors.lastname: Ready
authors.forename: Chandrajit P
authors.initials: CP
authors.lastname: Raut
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000150:complications; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012867:Skin / Q000473:pathology; D016038:Skin Transplantation; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects; D060726:Torso; D034941:Upper Extremity; D014945:Wound Healing; D055815:Young Adult