Davis AM, O'Sullivan B, Turcotte R, Bell R, Catton C, Chabot P, Wunder J, Hammond A, Benk V, Kandel R, Goddard K, Freeman C, Sadura A, Zee B, Day A, Tu D, Pater J, Canadian Sarcoma Group., NCI Canada Clinical Trial Group Randomized Trial., et al.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncol.... Date of publication 2005 Apr 1;volume 75(1):48-53.
1. Radiother Oncol. 2005 Apr;75(1):48-53.
Late radiation morbidity following randomization to preoperative versus
postoperative radiotherapy in extremity soft tissue sarcoma.
Davis AM(1), O'Sullivan B, Turcotte R, Bell R, Catton C, Chabot P, Wunder J,
Hammond A, Benk V, Kandel R, Goddard K, Freeman C, Sadura A, Zee B, Day A, Tu D,
Pater J; Canadian Sarcoma Group; NCI Canada Clinical Trial Group Randomized
Trial.
Author information:
(1)Toronto Rehabilitation Institute, Ont. M5G 2A2, Canada.
davis.aileen@torontorehab.on.ca
BACKGROUND AND PURPOSE: 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.
PATIENTS AND METHODS: 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.
RESULTS: 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).
CONCLUSIONS: Patients treated with postoperative radiotherapy tended to have
greater fibrosis. Fibrosis, joint stiffness and edema adversely affect patient
function.
PMID: 15948265 [Indexed for MEDLINE]
