Table 1.
Comparison of neoadjuvant vs. adjuvant acute and late wound complication in soft tissue sarcoma.
| Reference | Disease Site | RT Course (# Patients) |
Acute/ Late Toxicity | Measure | Neoadjuvant (%) | Adjuvant (%) | Significance |
|---|---|---|---|---|---|---|---|
| Pollack et al., 1998 [51] | MFH, synovial, and liposarcoma | Neoadjuvant 50Gy/25fx (n = 128), Adjuvant 60-66Gy/30–33fx (n = 165) | Acute | Wound complications | 25% | 6% * | p < 0.001 |
| Late | 5-, 10-, and 15-year actuarial incidence | 6, 7, and 7% respectively (Neoadjuvant & Adjuvant) | NS | ||||
| O’Sullivan et al., 2002 [58] | Upper & Lower Extremities | Neoadjuvant 50Gy/25fx (n = 88), Adjuvant 66Gy/33fx (n = 94) | Acute | Skin toxicity grade ≥2 | 36% | 68% * | p < 0.0001 |
| Wound complications | 35% | 17% * | p = 0.01 | ||||
| Late | MSTS (mean, scale 0–35) | 21 | 25 * | p = 0.01 | |||
| TESS (mean, scale 0–100) | 60 | 69 * | p = 0.01 | ||||
| SF-36 bodily pain (mean, scale 0–100) | 58 | 67 * | p = 0.03 | ||||
| Zagars et al., 2003 [52] | Head & Neck, Trunk, and Extremities | Neoadjuvant 50Gy (n = 271), Adjuvant 60Gy (n = 246)(1.8–2.0Gy/fx) | Late | 10-year actuarial complication incidence | 5% | 9% * | p = 0.03 |
| Necrosis, fractures, edema, or fibrosis | 4% | 8.9% | NR | ||||
| Davis et al., 2005 [11] | Upper & Lower Extremities | Neoadjuvant 50Gy/25fx (n = 73), Adjuvant 66Gy/33fx (n = 56) | Late | Subcutaneous fibrosis | 31.5% | 48.2% | NS |
| Joint stiffness | 17.8% | 23.2% | NS | ||||
| Edema | 15.1% | 23.2% | NS | ||||
| TESS (mean, scale 0–100) | 85.1 | 81.3 | NS | ||||
| MSTS (mean, scale 0–35) | 29.9 | 28.0 | NS | ||||
| O’Sullivan et al., 2013 [30] | Lower Extremities | Neoadjuvant 50Gy/25fx (n = 59), Compared to historical control of neoadjuvant from Davis et al., 2005 [11] | Acute | O’Sullivan 2013 | Davis et al., 2005 | ||
| Secondary operation | 33% | 43% | NS | ||||
| Seroma/hematoma drainage | 8.4% | NR | |||||
| Infection requiring debridement | 5.0% | NR | |||||
| Dressing changes/deep packing. 4 months post-surgery | 6.7% | NR | |||||
| Total wound complications | 30.5% | 43% | NS | ||||
| Late | Edema | 11.1% | 15.1% | NR | |||
| Skin Toxicity | 1.9% | NR | |||||
| Subcutaneous fibrosis | 9.3% | 31.5% | NR | ||||
| Fracture | 0% | NR | |||||
| Joint Stiffness | 5.6% | 17.8% | NR | ||||
| TESS (mean, scale 0–100) | 83.1 | 85.1 | NR | ||||
| MSTS-87 (mean, scale 0–35) | 31.5 | 29.9 | NR | ||||
| MSTS-93 (mean, scale 0–100) | 89.3 | NR | |||||
| Folkert et al., 2014 [36] | Upper & Lower Extremities | Neoadjuvant 50Gy median (n = 39), Adjuvant 63Gy median (n = 280) | Acute | Wound complications | 17.5% | 18.8% | NS |
| Radiation dermatitis | 48.7% | 31.5% | p = 0.002 | ||||
| Late | Fracture | 9.1% | 4.8% | NS | |||
| Joint stiffness | 11.0% | 14.5% | NS | ||||
| Edema | 14.9% | 7.9% * | p = 0.05 | ||||
| Nerve damage | 1.6% | 3.5% | NS | ||||
| Total | 36.6% | 30.7% | NR | ||||
| Muller et al. 2016 [59] | Upper & Lower Extremities | Neoadjuvant 59Gy mean (n = 89), Adjuvant 71Gy mean (n = 365) | Acute | Surgical revision | 9.0% | 4.4% | NS |
| Late | Wound necrosis, pathologic fractures, etc. | 11.2% | 15.2% | NS | |||
Abbreviations: #= number, * = Significance at p < 0.05, fx = fractions, Gy = Gray, MFH = Malignant Fibrous Histiocytoma, MSTS = Musculoskeletal Tumor Society Rating Scale (with updates -87 and -93), NR = Not Reported, NS = Not Significant, SF = Short Form, & TESS = Toronto Extremity Salvage Score.