{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T11:13:33Z","timestamp":1776424413449,"version":"3.51.2"},"reference-count":28,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2025,9,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The objective of this study was to evaluate whether dosimetric sparing of uninvolved normal tissues, including skin\/subcutaneous\n                      <jats:italic>flaps<\/jats:italic>\n                      , affects acute and late toxicities in preoperative image\u2010guided intensity\u2010modulated radiation therapy (IG\u2010IMRT) for lower extremity soft tissue sarcomas (LE\u2010STS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with LE\u2010STS from a phase 2 preoperative IG\u2010IMRT trial (flap\u2010sparing\u2010IMRT, 2005\u20132009) and a prospectively maintained institutional database (standard\u2010IMRT, 2005\u20132020) were propensity matched by age, sex, tumor size, grade, location, wound closure, and interval from IG\u2010IMRT to surgery; all received 50 Gy in 25 fractions preoperatively. The primary outcome was major wound complication (MWC). Secondary outcomes were late Radiation Therapy Oncology Group\u00a0toxicities, functional scores (Toronto Extremity Salvage Score [TESS];\u00a0Musculoskeletal Tumor Society scales [MSTS\u201087 or MSTS\u201093]), and oncologic outcomes. Kaplan\u2013Meier estimates, cumulative incidence functions, and linear, logistic, and Cox regression were used, as appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010five patients who received flap\u2010sparing\u2010IMRT were 1:5 matched to 275 patients who received standard\u2010IMRT (median follow\u2010up, 104 vs. 56 months, respectively). Regression analyses identified no significant association between treatment technique and MWCs (29% vs. 27%; odds ratio, 0.92;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.77), late grade 2 or greater toxicities: subcutaneous fibrosis (15% vs. 8%), joint stiffness (5% vs. 2%), edema (11% vs. 10%), fracture (2% vs. 4%), or functional outcomes (TESS, 87 vs. 89; MSTS\u201087, 33 vs. 33; and MSTS\u201093, 93 vs. 97; all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&gt;\u00a0.1). Five\u2010year overall survival (83.6% vs. 75.2%), disease\u2010free survival (65.5% vs. 64.1%), local recurrence (5.2% vs. 7.3%), distant metastasis (29.1% vs. 30.1%) were also comparable (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&gt;\u00a0.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Flap\u2010sparing\u2010IMRT with specific avoidance of uninvolved skin\/subcutaneous tissues demonstrated minimal differences in MWCs, late toxicity, and functional and oncologic outcomes compared with standard\u2010IMRT in patients with LE\u2010STS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.70049","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T17:28:33Z","timestamp":1757093313000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preoperative intensity\u2010modulated radiation therapy in lower extremity soft tissue sarcomas with and without dose avoidance of uninvolved skin\/subcutaneous tissue"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8232-4994","authenticated-orcid":false,"given":"Siyer","family":"Roohani","sequence":"first","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology Charit\u00e9\u2212Universit\u00e4tsmedizin Berlin Corporate member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"},{"name":"Berlin Institute of Health Biomedical Innovation Academy Berlin Institute of Health at Charit\u00e9\u2010Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4462-3974","authenticated-orcid":false,"given":"Anthony M.","family":"Griffin","sequence":"additional","affiliation":[{"name":"University Musculoskeletal Oncology Unit Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Orthopedic Surgery Department of Surgery Sinai Health System  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhihui Amy","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Princess Margaret Cancer Center University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles N.","family":"Catton","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen I.","family":"Dickie","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Ferguson","sequence":"additional","affiliation":[{"name":"University Musculoskeletal Oncology Unit Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Orthopedic Surgery Department of Surgery Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Surgical Oncology Princess Margaret Cancer Center University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David G.","family":"Kirsch","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David B.","family":"Shultz","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4329-2333","authenticated-orcid":false,"given":"Kim M.","family":"Tsoi","sequence":"additional","affiliation":[{"name":"University Musculoskeletal Oncology Unit Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Orthopedic Surgery Department of Surgery Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Surgical Oncology Princess Margaret Cancer Center University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7761-0283","authenticated-orcid":false,"given":"Philip","family":"Wong","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay S.","family":"Wunder","sequence":"additional","affiliation":[{"name":"University Musculoskeletal Oncology Unit Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Orthopedic Surgery Department of Surgery Sinai Health System  Toronto Ontario Canada"},{"name":"Department of Surgical Oncology Princess Margaret Cancer Center University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter W. M.","family":"Chung","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Center  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.1998.16.1.197"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(93)90236\u2010o"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2004.12.020"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(02)09292\u20109"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2021.04.005"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.01.062"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.07.2321"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11489"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21284"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/51\/13\/r21"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/27\/10\/002"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27951"},{"key":"e_1_2_10_14_1","volume-title":"ICRU Report 50: Prescribing, Recording, and Reporting Photon Beam Therapy","author":"International Commission on Radiation Units and Measurement (ICRU)","year":"1993"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v042.i08"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(95)00060\u2010c"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086\u2010199301000\u201000035"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf00540024"},{"key":"e_1_2_10_19_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2021"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.05.024"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2014.58.5828"},{"key":"e_1_2_10_22_1","volume-title":"Preoperative vs Postoperative IMRT for Truncal\/Extremity STS (Clinical Trials.gov identifier NCT02565498)","author":"Mount Sinai Hospital, Canada","year":"2024"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2016.12.028"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.2478\/raon\u20102023\u20100056"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpor.2019.02.007"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.10819"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2024.09.005"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110145"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.11758"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.70049","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncr.70049","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.70049","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T16:58:40Z","timestamp":1773853120000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.70049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":28,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2025,9,15]]}},"alternative-id":["10.1002\/cncr.70049"],"URL":"https:\/\/doi.org\/10.1002\/cncr.70049","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,5]]},"assertion":[{"value":"2025-06-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70049"}}