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CTOS, Berlin 2014 The influence of time interval between preoperative radiation and surgical resection on the development of wound healing complications.

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Presentation on theme: "CTOS, Berlin 2014 The influence of time interval between preoperative radiation and surgical resection on the development of wound healing complications."— Presentation transcript:

1 CTOS, Berlin 2014 The influence of time interval between preoperative radiation and surgical resection on the development of wound healing complications in extremity soft tissue sarcoma Anthony M. Griffin, MSc Colleen I. Dickie, MRT(T)(M.R.) Charles N. Catton, MD, FRCPC Peter W.M. Chung, MD, FRCPC Peter C. Ferguson, MD, FRCSC Jay S. Wunder, MD, FRCSC Brian O’Sullivan, MD, FRCPC

2 CTOS, Berlin 2014 Introduction Preop RT & extremity STS: smaller volume, lower dose, fewer late complications (fibrosis, fracture) Increased wound complications 1 30-45% in lower extremity 1 O’Sullivan, Lancet 2002; 359:2235

3 CTOS, Berlin 2014 Introduction Surgery usually 4-6 weeks post rads Cumulative effect of RT Timing of surgery after RT- influence outcome? But no empirical evidence for optimum time interval for minimizing WC.

4 CTOS, Berlin 2014 Purpose To determine if the time interval between completion of RT and surgery affects the development of wound complications in patients with extremity STS

5 CTOS, Berlin 2014 Methods Retrospective review of prospectively collected database Extremity STS Preoperative RT Chemotherapy excluded 1989-2013: 798 cases

6 CTOS, Berlin 2014 Methods Wound complications defined as: Secondary operations (debridement, flap, STSG) Invasive procedures for wound care (drainage of hematoma, seroma) Use of VAC Prolonged dressing changes, including packing of the wound for greater than six weeks from wound breakdown Readmission to hospital for wound care

7 CTOS, Berlin 2014 Methods Means compared with t-test Proportions compared with Chi-square test

8 CTOS, Berlin 2014 Results Mean age 56.1 (15-95) years 56% male (448); 44% female (350) 93% (743) primary presentations, 32 had metastases (2/55 with LR) 238 patients (30%) had prior unplanned excision Mean tumour size 8.8 cm (1-36 cm), Median 7.5 cm

9 CTOS, Berlin 2014 Results- Anatomic Site Upper Extremity 233 (29%) Lower extremity 565 (71%) Anatomic siteNumber Shoulder girdle69 Shoulder50 Elbow63 Wrist/ Hand51 Pelvic girdle42 Hip184 Knee272 Foot/ ankle67 Total798

10 CTOS, Berlin 2014 Results Subtype formerly known as MFH most common- did not re-classify MFH UPS tgg 1

11 CTOS, Berlin 2014 Results 654 (82%) deep Grade 1: 87 (11%) Grade 2: 293 (37%); Grade 3: 408 (51%) 10 not graded RT: external beam, planned to 50 Gy 56 patients (7%) had boost (10-16 Gy)

12 CTOS, Berlin 2014 Results- Flap or STSG usage Secondary closure in 324 (41%) Type of surgeryNumberPercentage Excision44555.8 Rotation flap577.1 Rotation flap + STSG11113.9 Free flap354.4 Free flap +STSG546.8 STSG678.4 Amputation101.3 Vascular reconstruction192.4 Total798100

13 CTOS, Berlin 2014 Results: RT-Surgery time & wound complications TotalMean time interval (days) Median (days) Range (days) P-value Entire group79841.340.04-470

14 CTOS, Berlin 2014 Results: RT-Surgery time & wound complications TotalMean time interval (days) Median (days) Range (days) P-value Entire group79841.340.04-470 Upper extremity23342.038.04-470* Lower extremity56541.140.04-1090.6 * If outlier is excluded, largest interval is 105 days

15 CTOS, Berlin 2014 Results: RT-Surgery time & wound complications TotalMean time interval (days) Median (days) Range (days) P-value Entire group79841.340.04-470 Upper extremity23342.038.04-470* Lower extremity56541.140.04-1090.6 Complication24240.940.54-100 No complication55641.540.04-4700.7 * If outlier is excluded, largest interval is 105 days

16 CTOS, Berlin 2014 Results: RT-Surgery time & wound complications TotalMean time interval (days) Median (days) Range (days) P-value Entire group79841.340.04-470 Upper extremity23342.038.04-470* Lower extremity56541.140.04-1090.6 Complication24240.940.54-100 No complication55641.540.04-4700.7 UE- complication3638.037.04-65 UE- no comp.19742.739.05-4700.4 * If outlier is excluded, largest interval is 105 days

17 CTOS, Berlin 2014 Results: RT-Surgery time & wound complications TotalMean time interval (days) Median (days) Range (days) P-value Entire group79841.340.04-470 Upper extremity23342.038.04-470* Lower extremity56541.140.04-1090.6 Complication24240.940.54-100 No complication55641.540.04-4700.7 UE- complication3638.037.04-65 UE- no comp.19742.739.05-4700.4 LE- complication20641.441.08-100 LE- no comp.35940.940.04-1090.6 * If outlier is excluded, largest interval is 105 days

18 CTOS, Berlin 2014 Results: RT-surgery interval & wound complications Time PeriodN=798ComplicationP-value 3 weeks39 (5%)15 (38%) > 3 weeks759 (95%)227 (30%)0.3

19 CTOS, Berlin 2014 Results: RT-surgery interval & wound complications Time PeriodN=798ComplicationP-value 3 weeks39 (5%)15 (38%) > 3 weeks759 (95%)227 (30%)0.3 4 weeks129 (16%)39 (30%) > 4 weeks669 (84%)203 (30%)1.0 5 weeks295 (37%)88 (30%) > 5 weeks503 (63%)154 (31%)0.8

20 CTOS, Berlin 2014 Results: RT-surgery interval & wound complications Time PeriodN=798ComplicationP-value 3 weeks39 (5%)15 (38%) > 3 weeks759 (95%)227 (30%)0.3 4 weeks129 (16%)39 (30%) > 4 weeks669 (84%)203 (30%)1.0 5 weeks295 (37%)88 (30%) > 5 weeks503 (63%)154 (31%)0.8 6 weeks476 (60%)133 (28%) > 6 weeks322 (40%)109 (34%)0.08

21 CTOS, Berlin 2014 Results: RT-surgery interval & wound complications- lower extremity Time PeriodN=565ComplicationP-value 3 weeks22 (4%)10 (45%) > 3 weeks543 (96%)196 (36%)0.4 4 weeks86 (15%)30 (35%) > 4 weeks479 (85%)176 (37%)0.7 5 weeks204 (36%)74 (36%) > 5 weeks361 (64%)132 (36%)0.9 6 weeks333 (59%)112 (34%) > 6 weeks232 (41%)94 (41%)0.09

22 Results- Secondary closure and wound complications Excludes 10 patients with amputations and 19 who required vascular reconstruction CTOS, Berlin 2014 NComplicationP-value Primary closure445141 (32%) Secondary closure32489 (28%)0.2

23 Results- Secondary closure and wound complications Excludes 10 patients with amputations and 19 who required vascular reconstruction CTOS, Berlin 2014 NComplicationP-value Primary closure445141 (32%) Secondary closure32489 (28%)0.2 LE- primary329123 (37%) LE- secondary20971 (34%)0.4

24 Results- IMRT vs. Pre-IMRT POP & conformal 1989-2005 Regular IMRT commenced in 2005, although foot and hand/ forearm still tend to be treated with POP (limited tissue sparing opportunities) CTOS, Berlin 2014 NComplicationP-value Pre-IMRT453134 (30%) IMRT345108 (31%)0.6

25 Results- IMRT vs. Pre-IMRT POP & conformal 1989-2005 Regular IMRT commenced in 2005, although foot and hand/ forearm still tend to be treated with POP (limited tissue sparing opportunities) CTOS, Berlin 2014 NComplicationP-value Pre-IMRT453134 (30%) IMRT345108 (31%)0.6 LE Pre-IMRT310110 (35%) LE IMRT25596 (38%)0.6

26 CTOS, Berlin 2014 Discussion Interval between RT completion & surgery had minimal influence on development of wound complications Small numbers within 3 weeks (39 patients) Interval of 4 or 5 weeks showed equivalent complication rates- optimal interval?

27 CTOS, Berlin 2014 Discussion Trend towards significance for surgery after 6 weeks Acute toxicities during treatment lead to delay in surgery? No difference with use of flap closure

28 CTOS, Berlin 2014 Thank You

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