Health-related quality of life after isolated limb perfusion compared to extended resection,or amputation for locally advanced extremity sarcoma: Is a limb salvage strategy worth the effort? |
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| Institution: | 1. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands;2. Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands;3. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands;4. Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom;5. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands;6. Department of Surgical Oncology, University Medical Center Groningen, Groningen, the Netherlands;7. Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands;8. Department of Orthopaedic Oncology, Leiden University Medical Center, Leiden, the Netherlands;9. Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands;10. Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands;1. Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA;2. European Interbalkan Medical Center, Asklipiou 10, Pilea, 555 35, Thessaloniki, Greece;3. Athens Medical Center, Distomou 5-7, Athens, 151 25, Greece;1. Department of Urology, The Christie NHS Foundation Trust, Manchester, UK;2. Radboudumc, Nijmegen, the Netherlands;3. University Medical Center Hamburg-Eppendorf, Hamburg, Germany;4. Department of Urology, Ruhr University Bochum, Klinikum, Herford, Germany;5. Urological Clinic Department of Surgical Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova, Italy;6. Department of Urology, St George''s University Hospitals NHS Trust, London, UK;7. NIHR Biomedical Research Centre UCLH and Division of Surgery and Interventional Science UCL, London, United Kingdom;8. Universitair Ziekenhuis Leuven, Leuven, Belgium;9. Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children''s Hospital, Nijmegen, the Netherlands;1. Surgery Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland;3. The Division of Digestive Surgery and Urology, Turku University Hospital and University of Turku, Turku, Finland;4. Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland;5. Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;6. Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland;7. Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland;8. Department of Pathology and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;9. Applied Tumor Genomics Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland;10. Department of Oesophageal and General Thoracic Surgery, Helsinki University Hospital and University of Helsinki, Finland;11. Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland;12. Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital and University of Tampere, Tampere, Tampere, Finland;13. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland;1. Surgery Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland;2. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden |
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| Abstract: | IntroductionThe aim of this study was to compare long-term patient reported outcomes (PROs) in patients with locally advanced extremity soft tissue sarcoma (eSTS) after isolated limb perfusion followed by resection (IR), compared to extended resection (ER), primary amputation (A) or secondary amputation after IR (IR-A).MethodsPatients were selected from the respondents of a multi-institutional cross-sectional cohort survivorship study (SURVSARC) conducted among sarcoma survivors registered in the Netherlands Cancer Registry (NCR), 2–10 years after diagnosis. Used PROs were the EORTC QLQ-C30, the Cancer worry scale (CWS), the Hospital Anxiety and Depression Scale (HADS), and the Toronto Extremity Salvage Score (TESS).ResultsWe identified 97 eSTS survivors: IR = 20, ER = 49, A = 20, IR-A = 8. While there were no differences in PROs between IR and ER, results showed better functioning and functionality in both groups versus the amputation groups. The amputation groups scored significantly lower on physical functioning (A = 62.7, IR-A = 65.7 versus IR = 78.0, ER = 82.7, p = 0.001) and role functioning (A = 67.5, IR-A = 52.8 versus IR = 79.2, ER = 80.6, p = 0.039), both EORTC QLQ-C30 scales. Also for the TESS, the scores were significantly lower for the amputation groups compared to the limb sparing groups (upper extremity p = 0.007 with A = 68.9, IR-A = 71.6 versus IR = 93.3, ER = 91.1; lower extremity p < 0.001 with A = 72.2, IR-A50.9 versus IR = 84.5 and ER = 85.5). There were no significant differences between the groups on cancer worry, anxiety and depression.ConclusionHRQoL in eSTS survivors treated with IR or ER is equal; for maintenance of physical functioning and functionality IR and ER outperform an amputation. |
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| Keywords: | Quality of life Soft tissue sarcoma Isolated limb perfusion Amputation |
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