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Function Preservation After Conservative Resection and Radiotherapy for Soft-tissue Sarcoma of the Distal Extremity: Utility and Application of the Toronto Extremity Salvage Score (TESS).
- Source :
-
American journal of clinical oncology [Am J Clin Oncol] 2016 Dec; Vol. 39 (6), pp. 600-603. - Publication Year :
- 2016
-
Abstract
- Objective: To evaluate outcomes after conservative resection and radiotherapy (RT) for soft-tissue sarcoma (STS) of the distal extremity, with assessment of functional quality of life using the validated Toronto Extremity Salvage Score (TESS) questionnaire and Common Terminology Criteria for Adverse Events (CTCAE), v4.0.<br />Methods: Thirty-three patients with STS involving the hand/wrist (N=18) or foot/ankle (N=15) complex received adjuvant RT with conservative resection and were evaluated for local tumor control, survival, toxicities, and preservation of objective functional ability. Eight patients were treated with preoperative RT (median dose, 50.4 Gy) and 25 with postoperative RT (median dose, 61.8 Gy). Median follow-up was 11.5 years. Functional outcomes were measured using TESS; patients with amputations were excluded from the TESS analysis. Adverse events related to gait, limb edema, skin infection, wound complication, and wound dehiscence were assessed using the CTCAE.<br />Results: The 5- and 10-year local control rates were both 90%. The 10-year cause-specific, absolute, and distant metastasis-free survival rates were 97%, 87%, and 84%, respectively. Three patients had an amputation for reasons other than local recurrence or treatment complications and underwent amputation for patient preference. One third of the subjects (11/33 patients) were able to complete the TESS questionnaire; scores ranged from 88 to 100 (mean, 98.2). CTCAEv4 acute adverse events occurred in 2 cases: 1 patient had a grade 3 skin infection and 1 had a grade 2 wound complication of dehiscence.<br />Conclusions: For management of distal extremity STS, the combination of adjuvant RT and conservative surgery achieves excellent local control and overall survival with few adverse events. In addition, through application of the TESS survey instrument, we have demonstrated that this treatment plan achieves robust functional preservation objectively and quantifiably.
- Subjects :
- Adult
Aged
Cohort Studies
Follow-Up Studies
Humans
Lower Extremity radiation effects
Lower Extremity surgery
Male
Middle Aged
Radiotherapy, Adjuvant methods
Reproducibility of Results
Retrospective Studies
Risk Assessment
Sarcoma mortality
Sarcoma pathology
Soft Tissue Neoplasms mortality
Soft Tissue Neoplasms pathology
Surveys and Questionnaires
Survival Rate
Survivors
Time Factors
Treatment Outcome
Limb Salvage classification
Quality of Life
Sarcoma radiotherapy
Sarcoma surgery
Soft Tissue Neoplasms radiotherapy
Soft Tissue Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1537-453X
- Volume :
- 39
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of clinical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 25036470
- Full Text :
- https://doi.org/10.1097/COC.0000000000000107