{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:51:14Z","timestamp":1792003874556,"version":"4.4.0"},"reference-count":39,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction: Soft tissue sarcomas of the extremities (ESTSs) pose significant challenges in treatment and management due to their diverse nature and potential complications. This study aimed to assess complications associated with multimodal treatments involving surgery and radiotherapy (RT) and to identify potential risk factors. Methods: We retrospectively analyzed nonmetastatic ESTS patients treated with surgery and pre- or post-operative RT between 2007 and 2020 in Strasbourg, France. Complications, including wound complications (WCs), lymphedema, acute and chronic RT-related complications, and fractures, were meticulously evaluated. Results: A total of 169 patients diagnosed with localized ESTSs were included, with a median age of 64 years (range 21\u201394 years). ESTSs primarily occurred proximally (74.6%) and in the lower limbs (71%). The median follow-up was 5.5 years. WCs occurred in 22.5% of patients, with proximal and lower extremity tumors being significant risk factors. Acute RT-related complications included radiodermatitis, with grade \u2265 2 occurring in 43.1% of patients, which was associated with superficial tumors. Three patients had an edema grade \u2265 2. Chronic complications included telangiectasias (21.7%) and fibrosis (38.7%), with higher rates associated with larger PTVs and higher RT doses, respectively. Fractures occurred in 5 patients, mainly in the tibia (40%). Conclusions: Multimodal treatment of ESTSs demonstrated excellent tolerance, with manageable side effects. Numerous risk factors have been highlighted, providing insights for optimizing treatment strategies and enhancing patient care in this rare disease.<\/jats:p>","DOI":"10.3390\/cancers16111977","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T09:04:25Z","timestamp":1716455065000},"page":"1977","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Complications and Risk Factors in Patients with Soft Tissue Sarcoma of the Extremities Treated with Radiotherapy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8391-8905","authenticated-orcid":false,"given":"Arthur","family":"Lebas","sequence":"first","affiliation":[{"name":"Radiotherapy Department, Institut de Canc\u00e9rologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Le Fevre","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Institut de Canc\u00e9rologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9156-2882","authenticated-orcid":false,"given":"Waisse","family":"Waissi","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, L\u00e9on B\u00e9rard Center, 28 Rue Laennec, 69008 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8102-771X","authenticated-orcid":false,"given":"Isabelle","family":"Chambrelant","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Institut de Canc\u00e9rologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Brinkert","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department, University Hospital of Hautepierre, 1 Rue Moli\u00e8re, 67200 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4952-5572","authenticated-orcid":false,"given":"Georges","family":"Noel","sequence":"additional","affiliation":[{"name":"Radiotherapy Department, Institut de Canc\u00e9rologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France"},{"name":"Faculty of Medicine, Strasbourg University, 4 Rue Kirschleger, 67000 Strasbourg, France"},{"name":"Radiobiology Laboratory, Centre Paul Strauss, IIMIS\u2014Imagerie Multimodale Integrative en Sant\u00e9, ICube, Strasbourg University, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/PAT.0000000000000050","article-title":"WHO Classification of Soft Tissue Tumours: An Update Based on the 2013 (4th) Edition","volume":"46","author":"Jo","year":"2014","journal-title":"Pathology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.ijrobp.2010.11.020","article-title":"Anatomic Tumor Location Influences the Success of Contemporary Limb-Sparing Surgery and Radiation among Adults with Soft Tissue Sarcomas of the Extremities","volume":"82","author":"Korah","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1007\/s001040051137","article-title":"Soft tissue sarcoma: Prognostic factors and multimodal treatment","volume":"71","author":"Hoos","year":"2000","journal-title":"Chir. Z. Alle Geb. Oper. Medizen"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"536","DOI":"10.6004\/jnccn.2018.0025","article-title":"Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology","volume":"16","author":"Randall","year":"2018","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"iv51","DOI":"10.1093\/annonc\/mdy096","article-title":"Soft Tissue and Visceral Sarcomas: ESMO-EURACAN Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up","volume":"29","author":"Casali","year":"2018","journal-title":"Ann. Oncol. Off. J. Eur. Soc. Med. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1016\/S0140-6736(02)09292-9","article-title":"Preoperative versus Postoperative Radiotherapy in Soft-Tissue Sarcoma of the Limbs: A Randomised Trial","volume":"359","author":"Davis","year":"2002","journal-title":"Lancet Lond. Engl."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.radonc.2004.12.020","article-title":"Late Radiation Morbidity Following Randomization to Preoperative versus Postoperative Radiotherapy in Extremity Soft Tissue Sarcoma","volume":"75","author":"Davis","year":"2005","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1200\/JCO.1998.16.1.197","article-title":"Randomized Prospective Study of the Benefit of Adjuvant Radiation Therapy in the Treatment of Soft Tissue Sarcomas of the Extremity","volume":"16","author":"Yang","year":"1998","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1200\/JCO.1994.12.6.1150","article-title":"A Prospective Randomized Trial of Adjuvant Brachytherapy in the Management of Low-Grade Soft Tissue Sarcomas of the Extremity and Superficial Trunk","volume":"12","author":"Pisters","year":"1994","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/0360-3016(95)00060-C","article-title":"Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)","volume":"31","author":"Cox","year":"1995","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_11","unstructured":"U.S. Department of Health and Human Services (2017). Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE), U.S. Department of Health and Human Services."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lebas, A., Le F\u00e8vre, C., Waissi, W., Chambrelant, I., Brinkert, D., and No\u00ebl, G. (2023). Prognostic Factors in Extremity Soft Tissue Sarcomas Treated with Radiotherapy: Systematic Review of the Literature. Cancers, 15.","DOI":"10.3390\/cancers15184486"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3236","DOI":"10.1200\/JCO.2013.53.9452","article-title":"Comparison of Local Recurrence with Conventional and Intensity-Modulated Radiation Therapy for Primary Soft-Tissue Sarcomas of the Extremity","volume":"32","author":"Folkert","year":"2014","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1002\/cncr.22298","article-title":"Complications of Combined Modality Treatment of Primary Lower Extremity Soft-Tissue Sarcomas","volume":"107","author":"Cannon","year":"2006","journal-title":"Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lebas, A., Le Fevre, C., Waissi, W., Chambrelant, I., Brinkert, D., and Noel, G. (2024). Factors Influencing Long-Term Local Recurrence, Distant Metastasis, and Survival in Patients with Soft Tissue Sarcoma of the Extremities Treated with Radiotherapy. Cancers, 16.","DOI":"10.3390\/cancers16101789"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s13014-018-1040-z","article-title":"The Alfa and Beta of Tumours: A Review of Parameters of the Linear-Quadratic Model, Derived from Clinical Radiotherapy Studies","volume":"13","author":"Oei","year":"2018","journal-title":"Radiat. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s13063-019-4026-8","article-title":"International Randomised Controlled Trial for the Treatment of Newly Diagnosed EWING Sarcoma Family of Tumours\u2014EURO EWING 2012 Protocol","volume":"21","author":"Anderton","year":"2020","journal-title":"Trials"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/0360-3016(93)90548-A","article-title":"Radiation Therapy Oncology Group: Radiosurgery Quality Assurance Guidelines","volume":"27","author":"Shaw","year":"1993","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ijrobp.2005.09.028","article-title":"Conformity Index: A Review","volume":"64","author":"Feuvret","year":"2006","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_20","first-page":"107086","article-title":"The Incidence, Risk Factors and Outcomes of Wound Complications after Preoperative Radiotherapy and Surgery for High Grade Extremity Soft Tissue Sarcomas: A 14-Year Retrospective Study","volume":"49","author":"Ouyang","year":"2023","journal-title":"Eur. J. Surg. Oncol. J. Eur. Soc. Surg. Oncol. Br. Assoc. Surg. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.1245\/s10434-015-4631-z","article-title":"The Influence of Time Interval between Preoperative Radiation and Surgical Resection on the Development of Wound Healing Complications in Extremity Soft Tissue Sarcoma","volume":"22","author":"Griffin","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/CORR.0000000000001287","article-title":"The Interval Between Preoperative Radiation and Surgery Is Not Associated with Overall Survival for Soft-Tissue Sarcomas: An Analysis of the National Cancer Database","volume":"479","author":"Collier","year":"2021","journal-title":"Clin. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2482","DOI":"10.1002\/1097-0142(19901215)66:12<2482::AID-CNCR2820661207>3.0.CO;2-L","article-title":"Conservative Surgery and Radiation Therapy for Soft Tissue Sarcoma of the Wrist, Hand, Ankle, and Foot","volume":"66","author":"Talbert","year":"1990","journal-title":"Cancer"},{"key":"ref_24","first-page":"1671","article-title":"Major Wound Complication Risk Factors Following Soft Tissue Sarcoma Resection","volume":"40","author":"Moore","year":"2014","journal-title":"Eur. J. Surg. Oncol. J. Eur. Soc. Surg. Oncol. Br. Assoc. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.bjps.2019.05.041","article-title":"Risk Factors for Postoperative Wound Complications after Extremity Soft Tissue Sarcoma Resection: A Systematic Review and Meta-Analyses","volume":"72","author":"Slump","year":"2019","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_26","first-page":"684","article-title":"Time Dependent Dynamics of Wound Complications after Preoperative Radiotherapy in Extremity Soft Tissue Sarcomas","volume":"45","author":"Lansu","year":"2019","journal-title":"Eur. J. Surg. Oncol. J. Eur. Soc. Surg. Oncol. Br. Assoc. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1016\/j.ejso.2017.01.018","article-title":"The Risk of Postoperative Complications and Functional Impairment after Multimodality Treatment for Limb and Trunk Wall Soft-Tissue Sarcoma: Long Term Results from a Monocentric Series","volume":"43","author":"Stoeckle","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1245\/s10434-012-2797-1","article-title":"Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface","volume":"20","author":"Baldini","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.rcot.2012.08.004","article-title":"Infection Pr\u00e9coce Du Site Op\u00e9ratoire En Traumatologie Des Membres de l\u2019adulte: Enqu\u00eate Prospective Multicentrique","volume":"98","author":"Bonnevialle","year":"2012","journal-title":"Rev. Chir. Orthop\u00e9dique Traumatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/(SICI)1096-9098(199602)61:2<90::AID-JSO2>3.0.CO;2-M","article-title":"Soft Tissue Sarcomas: Preoperative versus Postoperative Radiotherapy","volume":"61","author":"Cheng","year":"1996","journal-title":"J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1093\/annonc\/mdz124","article-title":"Surgery in Reference Centers Improves Survival of Sarcoma Patients: A Nationwide Study","volume":"30","author":"Blay","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.3747\/co.20.1308","article-title":"Surgical Margins and Handling of Soft-Tissue Sarcoma in Extremities: A Clinical Practice Guideline","volume":"20","author":"Kandel","year":"2013","journal-title":"Curr. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1002\/cam4.615","article-title":"Outcomes of Unplanned Sarcoma Excision: Impact of Residual Disease","volume":"5","author":"Charoenlap","year":"2016","journal-title":"Cancer Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3868","DOI":"10.1002\/cncr.31648","article-title":"Influence of Unplanned Excisions on the Outcomes of Patients with Stage III Extremity Soft-Tissue Sarcoma","volume":"124","author":"Traub","year":"2018","journal-title":"Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.ijrobp.2012.01.062","article-title":"Radiotherapy for Management of Extremity Soft Tissue Sarcomas: Why, When, and Where?","volume":"84","author":"Haas","year":"2012","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.canrad.2021.11.001","article-title":"Organs at Risk Radiation Dose Constraints","volume":"26","author":"Antoni","year":"2022","journal-title":"Cancer\/Radioth\u00e9rapie"},{"key":"ref_37","first-page":"243","article-title":"A Device and Procedure for Immobilization of Patients Receiving Limb-Preserving Radiotherapy for Soft Tissue Sarcoma","volume":"34","author":"Dickie","year":"2009","journal-title":"Med. Dosim. Off. J. Am. Assoc. Med. Dosim."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.radonc.2009.06.010","article-title":"Comparison of Conventional Radiotherapy and Intensity-Modulated Radiotherapy for Post-Operative Radiotherapy for Primary Extremity Soft Tissue Sarcoma","volume":"93","author":"Stewart","year":"2009","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1002\/cncr.27951","article-title":"Phase 2 Study of Preoperative Image-Guided Intensity-Modulated Radiation Therapy to Reduce Wound and Combined Modality Morbidities in Lower Extremity Soft Tissue Sarcoma","volume":"119","author":"Griffin","year":"2013","journal-title":"Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/11\/1977\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:47:06Z","timestamp":1760107626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/11\/1977"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["cancers16111977"],"URL":"https:\/\/doi.org\/10.3390\/cancers16111977","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,23]]}}}