Breast and Soft Tissue Implications of staged reconstruction and adjuvant brachytherapy in the treatment of recurrent soft tissue sarcoma

PURPOSE: 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. METHODS AND MATERIALS: 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(þ)) if there was microscopic involvement (R1) or # 1m m margin and negative (SM(� )) ifO1 mm margin was obtained. SR and IR were compared regarding toxicity, local control, and limb preservation. RESULTS: Median followup was 27 months. When comparing the SR (n 5 22) and IR (n 5 18) cohorts, there was a significantly lower final SM(þ) rate in SR (32% vs. 83%, p!0.01). A 2-year local control benefit seen with SR (80% vs. 34%; p 5 0.012) and a final SM(� ) (81% vs. 39%; p 5 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 5 4) or local recurrence (n 5 6). SR predicted for a benefit in 2-year limb preservation (88% vs. 50%; p 5 0.008). CONCLUSION: 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. 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.