Hyperbaric Oxygen Therapy, Sarcoma
Conditions
Brief summary
A parallel-group randomized pilot trial at a single institution (Duke University) on the effect of postoperative hyperbaric oxygen therapy on wound healing in patients with soft tissue sarcoma undergoing surgical resection with neo-adjuvant radiation therapy.. Participants will be allocated to either the treatment group (HBOT) or control (standard of care) by computer-generated randomization, stratified by tumor size (≤10cm and \>10cm). An unequal randomization of 2:1 will be utilized to provide experience prescribing HBOT to more patients.
Detailed description
Patients with a primary diagnosis of soft tissue sarcoma of the lower extremities undergoing treatment with neo-adjuvant radiation therapy and surgical resection will be screened for eligibility. All participants will receive pre-operative radiation treatment per standard of care and will undergo surgical excision as planned and performed by one of the surgical oncologists at our center. Participants randomized to the treatment group will be scheduled for 7-10 HBO treatments within 7-10 days of surgery. All participants will be scheduled for follow-up visits with their surgical oncologist at the following post-operative time points: 3, 6, 12, and 24-weeks (+/- 14 days). Follow up for the purposes of this study will continue up to 6 months from the time of surgery.
Interventions
DRUGHyperbaric oxygen
Patients with soft tissue sarcomas will receive HBOT treatment in the immediate postoperative period
Sponsors
Duke University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. Males and females within the ages of 18-85 2. Diagnosis of soft tissue sarcoma that has been histologically confirmed by an approved reference pathologist 3. Sarcoma of lower extremity location 4. Treatment plan that includes neo-adjuvant radiation therapy followed by surgical resection 5. Expected primary wound closure performed at the time at surgery 6. Any disease stage 7. Any tumor grade 8. Any histologic subtype 9. First or recurrent presentations 10. No vascular invasion or resection/repair/reconstruction that results in decreased perfusion of the extremity 11. No history of radiation therapy to the tumor and/or surgical area prior to the current treatment being studied 12. Must be able to comply with follow up visits 13. Must be able to provide own consent
Exclusion criteria
1. Patients under the age of 18, or over the age of 85. 2. Treatment plan that doesn't include neo-adjuvant radiation and surgical excision 3. Sarcoma location other than lower extremity 4. History of radiation therapy to the tumor and/or surgical area prior to the current treatment being studied 5. High dose steroid therapy (defined as \>5mg prednisone, or equivalent, daily) 6. Active treatment with chemotherapy 7. Inability of the patient to provide informed consent (i.e. dementia, cognitive impairment, non-English speakers) 8. Plan for post operative radiation therapy 9. Vascular invasion or resection/repair/reconstruction that results in decreased perfusion of the extremity 10. Vascular disease resulting in clinically apparent compromise in blood flow to the treatment extremity (i.e. peripheral vascular disease with diminished pulses, venous insufficiency with clinical evidence of vascular congestion) 11. Actively uncontrolled diabetes mellitus (documentation of history of diabetes mellitus with A1c\>8) 12. Active deep vein thrombosis in the treatment extremity 13. Inability to comply with follow up visits 14. Pregnant females (women of childbearing potential must have a negative serum pregnancy test prior to enrollment)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recruitment rate | Screening | The proportion of eligible patients who enroll in this study, as indicated by the screening log. |
| Hyperbaric Treatment Completion Rate | 24 weeks postoperatively | The proportion of prescribed hyperbaric oxygen treatments that are completed, which will be recorded in the appointment log. |
| Wound Assessment Form Completion Rate | 24 weeks postoperatively | The number of completed Wound Assessment Forms per participant divided by the total number of follow-up visits per participant. |
| Participant Assessment Form Completion Rate | 24 weeks postoperatively | Number of completed Participant Assessment Forms per participant divided by the number of total follow-up visits per participant. |
| patient reported study strengths and weaknesses | 24 weeks postoperatively | The Patient Feedback Survey will be given to all participants at their final study-related visit in order to collect qualitative and quantitative data on patient reported study strengths and weaknesses. |
| barriers to compliance with study procedures | 24 weeks postoperatively | The Patient Feedback Survey will be given to all participants at their final study-related visit in order to collect qualitative and quantitative data on patient reported barriers to compliance with study procedures |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of surgical site infections or periprosthetic infections | 24 weeks postoperatively | the number of participants with ≥ 1 completed Wound Assessment Form documenting infection or treatment for infection around the wound area at any follow-up visit. |
| frequency of wound complications that result in a secondary procedure | 24 weeks postoperatively | the number of participants with ≥ 1 completed Wound Assessment Form that documents reoperation or any other invasive procedure after primary resection with any wound complication as the indication for the procedure. |
| Wound Severity | 24 weeks postoperatively | Variability in clinical evaluations of wound severity will be determined by the Bates-Jensen Wound Assessment score recorded in the Wound Assessment Form. |
| Frequency of delayed wound healing | 24 weeks postoperatively | The frequency of delayed wound healing will be determined by the number of participants with of ≥ 1 completed Wound Assessment Form documenting ≥ 1 clinical indication of a wound complication at any follow-up visit. |
| Variability in Patient Reported Quality of Life | 24 weeks postoperatively | Variability in patient reported outcome data pertaining to quality of life will be determined by the ESAS-SM score alone at baseline and by the ESAS-SM and WOUND-Q: Life Impact scores recorded in the Participant Assessment Form at all follow-up visits. |
| Variability in Patient Reported Wound Assessments | 24 weeks postoperatively | Variability in patient reported outcome data pertaining to wound assessments will be determined by the WOUND-Q: Wound Characterization score recorded in the Participant Assessment Form at all follow-up visits. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORWilliam Eward, MD, DVM
Duke Health
Outcome results
None listed