Major wound complications after conventional preoperative radiotherapy in STS patients: incidence, predictors, and timing

In 2002, a major wound complication rate (MWC) of 35% was reported in the Canadian SR-2 trial after preoperative radiotherapy (RT) in soft-tissue sarcomas (STS). Recent literature reports a lower incidence of MWC. This study aims to evaluate the incidence, potential predictors, and duration of MWC over the last two decades.Data was collected from patients treated between October 2003 and October 2024, in curative setting, in a regimen of 25 fractions of 2 Gy, followed by surgery. Data was collected until 120 days post-surgery.In total, 164 patients were analyzed. The median interval between the last fraction of RT and surgery was 45 days (range 8-111). Patients had a mean age of 60.4 years (SD ± 14.0). STS were most commonly at the lower extremities (75.0%), had a mean tumor size of 9.2 cm (SD ± 5.1), and intermediate or high grade in 79.3% of the cases. The cohort was divided into subgroups: prior to 2020 and from 2020 onwards, due to the implementation of Volumetric Modulated Arc Therapy (VMAT) from 2020 onwards. MWC occurred in 26.2% of all patients, in 30.6% of patients treated before 2020, and in 17.9% of patients treated from 2020 onwards. In multivariate Cox proportional hazard regression model, treatment before 2020 (HR: 4.41, CI: 1.50-12.97), smoking (HR: 6.06, CI: 2.82-13.06), adiposity (HR: 2.73, CI: 1.27-5.89), and plastic reconstruction (HR: 2.45, CI: 1.18-5.11) were significantly associated with MWC.This study reports a lower incidence of MWC of 26.2% than historically reported. Patients treated before 2020, with adiposity, current smoking, or plastic reconstructions were at a higher risk of MWC.