Showing papers by "Robert S. Bell published in 1991"
TL;DR: In this paper, the authors compared the field size used for pre-operative irradiation with that necessary in the same patient had the radiation been given post-operatively, showing that the volume irradiated is smaller when irradiation is given preoperatively as compared to postoperatively.
Abstract: For the treatment of soft tissue sarcomas it has frequently been staged but not quantitatively demonstrated, that the volume irradiated is smaller when irradiation is given preoperatively as compared to postoperatively. In this study the field size used for preoperative irradiation was compared with that necessary in the same patient had the radiation been given postoperatively. Twenty-six patients with soft tissue sarcomas of the extremity, groin, and shoulder girdle who had received preoperative irradiation were resimulated following surgery to determine the size of the postoperative field. The simulation was performed by a physician not involved in the preoperative treatment planning. Preoperatively a radial margin of 5 cm around the tumor was used for low and intermediate grade and 7 cm for high grade sarcomas. Postoperatively the same margins were used but around the surgical field. Twelve patients underwent a wide resection and 14 patients a resection followed by vascularized tissue transfer to the surgical bed. The median follow-up was 22 months (range 13-46). No local recurrences and two cases of distant metastasis were observed. Independently of surgical procedure and tumor grade, the size of the preoperative radiation field and number of joints included in the field were significantly smaller than that of postoperative radiation (p less than 0.001). In two patients preoperatively and four patients postoperatively, the radiation field involved the whole circumference of the limb. Provided that equivalent radiation time-dose-fraction parameters are used and that the complication rate is proportional to the radiation field size, late complications may be less after preoperative irradiation than after post-operative irradiation.
141 citations
TL;DR: Univariate analysis demonstrated that large tumour size, postoperative complications, and neural sacrifice were associated with poor functional outcome.
Abstract: One hundred five consecutive patients underwent surgical resection and adjuvant irradiation in treatment of soft tissue sarcoma or aggressive fibromatosis All patients were entered in a prospective study evaluating functional outcome and 88 patients were examined at 12 months following surgery Outcome was characterized using the Enneking system as well as documenting employment/recreational status and limb edema Sixty-eight of 88 patients had functional scores of 21 or better (out of a possible total of 35) Forty-four patients were serially evaluated at 12 and 24 months and there was no difference in their outcome at the 2 time points Univariate analysis demonstrated that large tumour size, postoperative complications, and neural sacrifice were associated with poor functional outcome
89 citations
TL;DR: The data should be considered as preliminary, rather than definitive, evidence of the efficacy of vascularized tissue transfer, as the only variable influencing length of stay was the use of tissue transfer.
Abstract: A prospective, nonrandomized comparison of three treatment protocols was undertaken in 45 patients with soft tissue sarcoma designated preoperatively as being at high risk of wound healing complications. All patients underwent complete resection of the gross tumour mass (5 with positive and 40 with negative microscopic margins). Fourteen patients received postoperative adjuvant irradiation (group I), 16 preoperative irradiation (group II), and 15 preoperative irradiation and vascularized tissue transfer to the surgical bed after resection (group III). Major wound healing complications (defined as complications requiring at least 1 further surgical procedure) were lower in group III patients (chi-square = 5.57, P less than 0.03), as was the mean postoperative hospital stay (P less than 0.02, analysis of variance), and the mean number of secondary surgical procedures. Multivariate analysis showed that the only variable influencing length of stay was the use of tissue transfer. Careful intraoperative assessment of the adequacy of resection is essential prior to performing vascularized tissue transfer to ensure that tumour contamination of the donor site is avoided. Since this study is a nonrandomized clinical trial using sequential distribution of patients to the treatment groups, the data should be considered as preliminary, rather than definitive, evidence of the efficacy of vascularized tissue transfer.
21 citations
TL;DR: Patients requiring bony cortex resection for STS of the lower extremity should be considered at risk for late fracture if adjuvant irradiation is prescribed.
Abstract: In a prospective study, consecutive patients were treated for soft-tissue sarcoma (STS) by wide resection and adjuvant irradiation. Twelve patients had resection of bone to achieve a tumor free margin; five of these patients were left with lower extremity open segmental cortical defects in the high-dose radiation field. Four of the five patients with cortical defects suffered a fracture through the defect more than six months after surgery. Only one of 71 patients not treated with bony resection suffered a late fracture. Patients requiring bony cortex resection for STS of the lower extremity should be considered at risk for late fracture if adjuvant irradiation is prescribed.
17 citations