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Abstract
This study compared late radiation morbidity in patients with extremity soft tissue
sarcoma randomized to treatment by pre- (50 Gy) or postoperative (66 Gy) radiotherapy
in combination with surgery. The morbidities evaluated included fibrosis, joint stiffness
and edema at 2 years following treatment. The impact of morbidity on patient function
as measured by the Musculoskeletal Tumor Rating Scale (MSTS) and the Toronto Extremity
Salvage Score (TESS) was also evaluated.
129 patients were evaluated. Toxicity rates were compared by treatment arm using the
Fisher's exact test. Function scores by toxicity were analyzed using the Wilcoxon
rank sum test. Multivariate logistic regression was used to evaluate the joint effect
of treatment arm, field size, and dose on subcutaneous tissue fibrosis, joint stiffness
and edema.
27 of 56 patients (48.2%) in the postoperative arm compared to 23 of 73 (31.5%) in
the preoperative arm had grade 2 or greater fibrosis (P = 0.07). Although not statistically
significant, edema was more frequent in the postoperative arm, 13 of 56 (23.2%) versus
11 of 73 (15.5%) in the preoperative arm, as was joint stiffness, 13 of 56 (23.2%)
versus 13 of 73 (17.8%). Patients with significant fibrosis, joint stiffness or edema
had significantly lower function scores on both measures (all P-values < 0.01). Field
size was predictive of greater rates of fibrosis (P = 0.002) and joint stiffness (P
= 0.006) and marginally predictive of edema (P = 0.06).
Patients treated with postoperative radiotherapy tended to have greater fibrosis.
Fibrosis, joint stiffness and edema adversely affect patient function.