title: Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma.
abstract: BACKGROUND
  This study sought to determine if preoperative image-guided intensity-modulated radiotherapy (IG-IMRT) can reduce morbidity, including wound complications, by minimizing dose to uninvolved tissues in adults with lower extremity soft tissue sarcoma.
  
  
  METHODS
  The primary endpoint was the development of an acute wound complication (WC). IG-IMRT was used to conform volumes to avoid normal tissues (skin flaps for wound closure, bone, or other uninvolved soft tissues). From July 2005 to June 2009, 70 adults were enrolled; 59 were evaluable for the primary endpoint. Median tumor size was 9.5 cm; 55 tumors (93%) were high-grade and 58 (98%) were deep to fascia.
  
  
  RESULTS
  Eighteen (30.5%) patients developed WCs. This was not statistically significantly different from the result of the National Cancer Institute of Canada SR2 trial (P = .2); however, primary closure technique was possible more often (55 of 59 patients [93.2%] versus 50 of 70 patients [71.4%]; P = .002), and secondary operations for WCs were somewhat reduced (6 of 18 patients [33%] versus 13 of 30 patients [43%]; P = .55). Moderate edema, skin, subcutaneous, and joint toxicity was present in 6 (11.1%), 1 (1.9%), 5 (9.3%), and 3 (5.6%) patients, respectively, but there were no bone fractures. Four local recurrences (6.8%, none near the flaps) occurred with median follow-up of 49 months.
  
  
  CONCLUSIONS
  The 30.5% incidence of WCs was numerically lower than the 43% risk derived from the National Cancer Institute of Canada SR2 trial, but did not reach statistical significance. Preoperative IG-IMRT significantly diminished the need for tissue transfer. RT chronic morbidities and the need for subsequent secondary operations for WCs were lowered, although not significantly, whereas good limb function was maintained.
authors: Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Brian
authors: B
authors: O'Sullivan
authors: Anthony M
authors: AM
authors: Griffin
authors: Colleen I
authors: CI
authors: Dickie
authors: Michael B
authors: MB
authors: Sharpe
authors: Peter W M
authors: PW
authors: Chung
authors: Charles N
authors: CN
authors: Catton
authors: Peter C
authors: PC
authors: Ferguson
authors: Jay S
authors: JS
authors: Wunder
authors: Benjamin M
authors: BM
authors: Deheshi
authors: Lawrence M
authors: LM
authors: White
authors: Rita A
authors: RA
authors: Kandel
authors: David A
authors: DA
authors: Jaffray
authors: Robert S
authors: RS
authors: Bell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D005354:Fibrosarcoma / Q000532:radiotherapy / Q000601:surgery; D006394:Hemangiosarcoma / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007890:Leiomyosarcoma / Q000532:radiotherapy / Q000601:surgery; D008080:Liposarcoma / Q000532:radiotherapy / Q000601:surgery; D035002:Lower Extremity / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods*; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D013584:Sarcoma, Synovial / Q000532:radiotherapy / Q000601:surgery; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome