Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2012 Mar;129(3):675-682.
doi: 10.1097/PRS.0b013e3182412a39.

The effect of neoadjuvant versus adjuvant irradiation on microvascular free flap reconstruction in sarcoma patients

Albert H Chao  1 , David W Chang, Stefan W Shuaib, Matthew M Hanasono
Affiliations
Comparative Study

The effect of neoadjuvant versus adjuvant irradiation on microvascular free flap reconstruction in sarcoma patients

Albert H Chao et al. Plast Reconstr Surg. 2012 Mar.

Abstract

Background: Sarcoma patients often require radiation therapy in addition to surgical resection. Although neoadjuvant irradiation possesses advantages over adjuvant irradiation related to smaller doses and field sizes, existing studies suggest adverse effects on wound healing and possibly microvascular free flap success. Conversely, microvascular reconstruction may counteract some of the negative effects of irradiation by replacing irradiated tissue with well-vascularized unirradiated tissue from a distant site.

Methods: A review of sarcoma patients who underwent resection, microsurgical reconstruction, and either neoadjuvant or adjuvant irradiation was performed.

Results: A total of 119 patients met inclusion criteria, of which 73 underwent neoadjuvant irradiation and 46 underwent adjuvant irradiation. Sarcomas were located in the head and neck (n = 47), trunk (n = 7), upper extremity (n = 15), and lower extremity (n = 50). The rate of perioperative (≤ 30 days) complications was 26.9 percent, whereas the rate of late recipient-site complications was 14.3 percent. No significant differences in perioperative recipient-site (p = 0.19), donor-site (p = 1.00), or medical complications (p = 0.30) were observed between patients undergoing neoadjuvant and adjuvant irradiation. Free flap loss rates were lower in patients undergoing neoadjuvant irradiation (0 percent versus 8.7 percent, respectively; p = 0.02). Late recipient-site complications occurred less often in patients undergoing neoadjuvant radiation (6.8 percent versus 26.1 percent, respectively; p = 0.006).

Conclusions: Neoadjuvant irradiation does not increase the risk of acute wound or microvascular complications when combined with free flap reconstruction, and is associated with fewer late recipient-site complications than adjuvant irradiation. These factors should be considered when determining the timing of radiation therapy in sarcoma patients undergoing oncologic resections and microsurgical reconstruction.

Clinical question/level of evidence: Therapeutic, III.

PubMed Disclaimer

References

    1. Cannon CP, Ballo MT, Zagars GK, et al.. Complications of combined modality treatment of primary lower extremity soft-tissue sarcomas. Cancer 2006;107:2455–2461.
    1. Cheng EY, Dusenbery KE, Winters MR, Thompson RC. Soft tissue sarcomas: Preoperative versus postoperative radiotherapy. J Surg Oncol. 1996;61:90–99.
    1. O'Sullivan B, Davis AM, Turcotte R, et al.. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: A randomised trial. Lancet 2002;359:2235–2241.
    1. O'Sullivan B, Gullane P, Irish J, et al.. Preoperative radiotherapy for adult head and neck soft tissue sarcoma: Assessment of wound complication rates and cancer outcome in a prospective series. World J Surg. 2003;27:875–883.
    1. Kaushal A, Citrin D. The role of radiation therapy in the management of sarcomas. Surg Clin North Am. 2008;88:629–646.

Publication types