title: Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma.
abstract: Prior studies illustrated a reduction in wound complications with the use of staged reconstruction (SR) and negative pressure wound therapy when treating soft tissue sarcoma (STS) with surgical resection followed by high-dose-rate adjuvant brachytherapy. The purpose of this study is to compare the outcomes of SR and immediate reconstruction (IR) brachytherapy in recurrent STS.
  
  
  
  A retrospective review of 40 patients with recurrent STS of the local extremity and trunk treated with resection followed by adjuvant brachytherapy alone. Margin status was defined as positive (SM(+)) if there was microscopic involvement (R1) or ≤1 mm margin and negative (SM(-)) if >1 mm margin was obtained. SR and IR were compared regarding toxicity, local control, and limb preservation.
  
  
  
  Median followup was 27 months. When comparing the SR (n = 22) and IR (n = 18) cohorts, there was a significantly lower final SM(+) rate in SR (32% vs. 83%, p < 0.01). A 2-year local control benefit seen with SR (80% vs. 34%; p = 0.012) and a final SM(-) (81% vs. 39%; p = 0.023). SR was associated with less toxicity on multivariate analysis, including a 90% decrease in persistent edema, an 80% decrease in wound dehiscence, and a 94% decrease in nonhealing wounds, when compared to IR. Ten of 31 (32%) extremity cases required eventual amputation from either chronic wound complications (n = 4) or local recurrence (n = 6). SR predicted for a benefit in 2-year limb preservation (88% vs. 50%; p = 0.008).
  
  
  
  In our series, the treatment with SR brachytherapy resulted in less morbidity and an improved final SM(-) rate. This technique translated to an improvement in both local control and limb preservation of recurrent STS.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Arash O
authors.initials: AO
authors.lastname: Naghavi
authors.affiliation: Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Scott
authors.affiliation: Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: John E
authors.initials: JE
authors.lastname: Mullinax
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Yazan A
authors.initials: YA
authors.lastname: Abuodeh
authors.affiliation: Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Youngchul
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Odion
authors.initials: O
authors.lastname: Binitie
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Kamran A
authors.initials: KA
authors.lastname: Ahmed
authors.affiliation: Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Bui
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Amarjit S
authors.initials: AS
authors.lastname: Saini
authors.affiliation: Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Biagioli
authors.affiliation: Sarcoma Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Douglas
authors.initials: D
authors.lastname: Letson
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. Electronic address: Daniel.fernandez@moffitt.org.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005121:Extremities; D005260:Female; D005354:Fibrosarcoma / Q000532:radiotherapy; D005500:Follow-Up Studies; D006801:Humans; D008080:Liposarcoma / Q000532:radiotherapy; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D009236:Myxosarcoma / Q000532:radiotherapy; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000379:methods; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012509:Sarcoma / Q000532:radiotherapy*; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy*; D013524:Surgical Flaps; D013997:Time Factors; D014945:Wound Healing; D055815:Young Adult
keywords: Adjuvant; Brachytherapy; Delayed reconstruction; Negative pressure wound therapy; Radiation; Recurrent; STS; Sarcoma; Staged reconstruction; Vacuum