title: Quality of life, functional outcomes, and wound complications in patients with soft tissue sarcomas treated with preoperative chemoradiation: a prospective study.
abstract: BACKGROUND
  Preoperative irradiation reduces local recurrence of soft tissue sarcomas (STSs), but major wound complication rates approach 25-35 %. Using a novel neoadjuvant chemoradiation protocol, we prospectively documented functional outcomes and quality of life (QOL) and hypothesized a lower major wound complication rate.
  
  
  METHODS
  Patients with STS deep to muscular fascia were treated with 3 days of doxorubicin (30 mg/day) and 10 days of irradiation (300 cGy/day) followed by limb-sparing surgery. Wound complications were assessed, and functional assessment and QOL were followed prospectively using the Toronto Extremity Salvage Score (TESS), Musculoskeletal Tumor Society (MSTS), and Short Form (SF)-36 questionnaires preoperatively and 6 and 12 months postoperatively.
  
  
  RESULTS
  Altogether, 52 consecutive patients were accrued during 2006-2011. Overall, 80.8 % of STSs were >5 cm, and 67.3 % involved the lower extremity. Seven (13.5 %) major wound complications occurred, all requiring reoperation. Preoperative scores for TESS, MSTS, and SF-36 physical (PCS) and mental (MCS) health components were 83.3, 86.7, 40.6, and 49.4, respectively. There were no differences seen 6 months postoperatively. By 12 months, however, patients showed improved functional scores (TESS 93.0, p = 0.02; MSTS 93.3, p < 0.01) and QOL scores (PCS 45.1, p = 0.02; MCS = 52.9, p = 0.05). No differences in scores were seen between patients with or without wound complications.
  
  
  CONCLUSIONS
  Patients treated with our neoadjuvant chemoradiation protocol had stable QOL and functional scores 6 months postoperatively and showed improvement by 12 months. Importantly, the major wound complication rate was low.
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, MB, Canada, jrivard@exchange.hsc.mb.ca.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Rivard
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Puloski
authors.forename: Walley J
authors.initials: WJ
authors.lastname: Temple
authors.forename: Allison
authors.initials: A
authors.lastname: Fyfe
authors.forename: Michael
authors.initials: M
authors.lastname: Kwan
authors.forename: Norman
authors.initials: N
authors.lastname: Schachar
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kurien
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lanuke
authors.forename: Lloyd A
authors.initials: LA
authors.lastname: Mack
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012509:Sarcoma / Q000150:complications*; D014947:Wounds and Injuries / Q000209:etiology*; D055815:Young Adult